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Session: ePoster: Rectal Cancer 7 (Mon8)

EP675 - Role of Adjuvant Chemotherapy following Total Neoadjuvant Therapy and Surgery in Stage III Clinically Node-Positive, Pathologic-Node Negative Locally-Advanced Rectal Cancer

Monday, May 12, 2025
8:32 AM – 8:37 AM PT
Location: Monitor 10, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Michael H. Froehlich, MD (he/him/his)

    General Surgery Resident
    Stony Brook University Hospital
    Stony Brook University Hospital
    Stony Brook, NY, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • SY

    Suresh B. Yelika, MD

    Assistant Professor of Surgery
    Stony Brook University
    Selden, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • NA

    Nicholas J. Ahn, MD

    Assistant professor
    Stony Brook University Hospital
    Port Jefferson, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • PD

    Paula I. Denoya, MD

    Clinical Associate Professor of Surgery
    Renaissance School of Medicine at Stony Brook University
    Stony Brook, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • DN

    Deborah Nagle, MD

    Chief, Division of Colon and Rectal Surgery
    Stony Brook University Hospital
    Stony Brook, New York, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Michael H. Froehlich, MD: This individual has no financial relationships with ineligible companies.
Suresh B. Yelika, MD: This individual has no financial relationships with ineligible companies.
Nicholas J. Ahn, MD: This individual has no financial relationships with ineligible companies.
Paula I. Denoya, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The role of adjuvant chemotherapy (AC) is not well defined in clinically node-positive stage III rectal cancer in patients who are pathologically node-negative following total neoadjuvant therapy (TNT) and surgical resection.1-6 There is also increased risk for inadequate lymph node harvest (LNH) in patients who undergo TNT, as well as worse survival in those who are pathologically node negative within this population.7-10 There is also literature that brings into question the prognostic significance of LNH with regards to overall survival (OS) in this population.11 The aim of this study was to evaluate whether receiving AC on the basis of lymph node harvest impacts OS in this specific population.

Methods/Interventions: Retrospective analysis was performed in patients with clinical Stage III locally-advanced rectal cancer (LARC) between 2005-2020 from the National Cancer Database (NCDB) who underwent surgery following TNT. Patients were stratified by whether or not they had lymph node harvest (LNH) greater than or less than 12 nodes, as well as whether or not they received AC. We analyzed demographics, clinical and pathologic staging, and overall survival using Pearson Chi-Squared tests, Kaplan-Meier survival analysis, and Cox Regression.

Results/Outcomes: 13,135 patients were included. Patients with LNH < 12 who did not receive AC (Group 1) were significantly older than all other groups (p < 0.001) and had significantly higher Charlson-Deyo Comorbidity Index Score (p < 0.001). Patients with LNH < 12 who did not receive AC (Group 1) had significantly worse OS compared to all groups (p < 0.001). Patients with LNH>/=12 and received AC (Group 4) had greater OS than patients with LNH>/=12 who did not received AC (Group 3) (p < 0.001, HR: 0.60, 95% CI:0.55-0.67) and patients with LNH < 12 who received AC (Group 2) (p < 0.001, HR:0.75, 95% CI:0.64-0.87). Patients with LNH < 12 who received AC (Group 2) had significantly better OS than those with LNH>/=12 who did not receive AC (Group 3) (p=0.002, HR 0.81, 95% CI: 0.71-0.93).

Conclusion/Discussion: In clinical node-positive, pathological node-negative Stage III LARC following TNT and surgical resection, those who do not receive AC had worse overall survival, irrespective of whether LNH>/=12 is achieved. Thus, adjuvant chemotherapy should be considered in all clinical node-positive, pathological node-negative Stage III LARC following TNT and surgical resection.