| Summary: | Abstract Rectal mucinous adenocarcinoma (RMAC) is a rare and aggressive form of rectal cancer. The effectiveness of neoadjuvant radiotherapy (NRT) for RMAC has not been well studied, and the survival benefit remains controversial. The purpose of this work was to determine the prognostic role of NRT in patients with RMAC by propensity-score matching (PSM). A retrospective cohort study using the Surveillance, Epidemiology, and End Results from 2004 to 2015 was performed. In the multivariate analysis before PSM, NRT provided better OS (HR 0.61, 95% CI 0.52–0.71, p < 0.001) and CSS (HR 0.68, 95% CI 0.56–0.82, p < 0.001). Multivariate analysis after PSM (n = 844) confirmed that patients receiving NRT survived longer than those without NRT (OS: HR 0.60, 95% CI 0.50–0.78, p < 0.001 and CSS: HR 0.68, 95% CI 0.54–0.84, p < 0.001). Subgroup analysis indicated that NRT had significantly improved OS and CSS in stage II RMAC and OS in stage III RMAC after adjusting for various confounding factors.
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