Adjuvant radiotherapy improves cause specific survival in stage II, not stage III mucinous carcinoma of the rectum

BACKGROUND: The effect of adjuvant radiotherapy on the survival outcomes of patients with mucinous rectal cancer remains unclear. This study evaluated the 5-year cause specific survival (CSS) of patients with mucinous rectal cancer after surgery to determine whether adjuvant radiotherapy conferred a survival benefit. METHODS: An analysis of the Surveillance, Epidemiology, and End Results (SEER)-registered database was conducted of patients presenting with mucinous rectal cancer between 2004 and 2011. The primary endpoint was 5-year CSS; univariate and multivariate analyses were performed using Cox proportional hazards regression models. RESULTS: A total of 574 patients were included for analysis with 248 patients in postoperative radiotherapy group and 326 patients in surgery alone group. Preliminary analysis demonstrated that adjuvant radiotherapy was not associated with CSS (χ (2) = 0.560, P = 0.454). Subgroup analysis indicated that postoperative radiotherapy group had survival advantage in stage II rectal cancer (93.3% vs. 76.6%, χ (2) = 4.654, P = 0.031), but not in stage III rectal cancer (67.5% vs. 64.7%, χ (2) = 0.186, P = 0.666). Multivariate analysis demonstrated that postoperative radiotherapy group had a reduced risk of death on survival (HR 0.346; 95%CI 0.129-0.927, P = 0.035) CONCLUSION: Postoperative radiotherapy is an independent factor for improvement in CSS in patients with stage II rectal mucinous adenocarcinoma, and it should be routinely recommended in these patients. But for stage III patients, considering the losing of CSS advantage and potential radiotherapy toxicity, postoperative radiotherapy should be recommended with great caution.