Validity in Propensity Score–Matched Estimates of Adjuvant Chemotherapy Effects in Rectal Cancer

Current treatment guidelines in the United States for patients with stage T3 or greater or N+ rectal cancer recommend neoadjuvant chemoradiation therapy (nCRT) and 6 months of perioperative chemotherapy. However, there exists a paucity of direct evidence to support the administration of adjuvant chemotherapy following nCRT and radical surgery. The indication for adjuvant chemotherapy in these patients is therefore an important clinical concern and the topic of debate. In this issue of JAMA Oncology, 2 separate observational cohort studies have used the National Cancer Database (NCDB) to evaluate the association between adjuvant chemotherapy and overall survival among patients with ypT0N0 rectal cancer following nCRT and surgery. They conclude that adjuvant chemotherapy may improve survival. So do these 2 reports finally provide adequate support for current treatment guidelines?

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