The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision

Yuan Zhou; Dan Wang; Fengbo Tan; Zhongyi Zhou; Lilan Zhao; Cenap Güngör; Qian Pei; Yuqiang Li; Wenxue Liu

doi:10.7150/jca.70894

The survival impact of radiotherapy on synchronous metastatic rectal cancer: metastatic site can serve for radiotherapy-decision

J Cancer. 2022 Apr 4;13(7):2171-2178. doi: 10.7150/jca.70894. eCollection 2022.

Authors

Yuan Zhou^{1

2}, Dan Wang^{1

2

3}, Fengbo Tan^{1

2}, Zhongyi Zhou^{1

2}, Lilan Zhao⁴, Cenap Güngör³, Qian Pei^{1

2}, Yuqiang Li^{1

2

3}, Wenxue Liu^{2

5}

Affiliations

¹ Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Thoracic surgery, Fujian Provincial Hospital, Fuzhou, China.
⁵ Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Purpose: The metastatic site seems to represent a malignancy with a different biological characteristic. Radiotherapy, as a successful, well-tolerated, cost-effective and time-efficient intervention, is able to provide clear benefits for the treatment of locally advanced rectal cancer and has become an essential component of palliative oncology care. The real-world effect of radiotherapy on the survival outcomes of metastatic rectal cancer (mRC) patients might do exist and was worth exploring. Patients and methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective analysis. The statistical methods included Pearson's chi-square test, Log-rank test, Cox regression model and propensity score matching (PSM). Results: The multivariable Cox regression displayed that radiotherapy may not be used as a prognostic factor for mRC (p=0.057). However, radiotherapy may be associated with the prognosis if the metastatic site was excluded from the multivariate analysis (p<0.001). Radiotherapy seemed to fail to improve OS before PSM (p<0.001) and after PSM without the metastatic site as a matching factor (p<0.001). Nevertheless, there was no significant survival difference between radiotherapy and non-radiotherapy cohort after PSM with the metastatic site as a matching factor (p=0.057). All of M1a rectal cancer patients appear to obtain survival benefit from radiotherapy without the impact of PSM (p<0.001). Notwithstanding, radiotherapy was associated with improved OS of patients with rectal liver-limited metastasis (p=0.023) and did not appear to provide survival benefit for rectal lung-limited (p=0.386) and other-limited metastasis (p=0.385). Both of M1b mRC with and without liver metastasis did not seem to obtain survival benefit from radiotherapy. Conclusions: Carefully selected data from the SEER database suggested that radiotherapy appears to improve overall survival only in patients with rectal liver-limited metastasis.

Keywords: SEER database; metastatic site; overall survival; radiotherapy; rectal cancer.