AbstractBackgroundNeoadjuvant chemoradiotherapy (NACRT) and total mesorectal excision (TME) are standard treatments of stage II/III locally advanced rectal cancer (LARC), currently. Here, we evaluated the oncological outcomes in LARC patients treated with NACRT compared to TME alone, and determined whether tumor regression grade (TRG) and pathologic response after NACRT was related to prognosis.MethodsThis is a retrospective comparison of 358 LARC patients treated with either TME alone (non‐NACRT group, n = 173) or NACRT plus TME (NACRT group, n = 185) during 2003–2013. Perioperative and oncologic outcomes, like overall survival (OS), disease‐free survival (DFS) and recurrence were compared using 1:1 propensity score matching analysis.ResultsA total of 133 patients were matched for the analysis. After a median follow‐up of 45 months (8–97 months), the 5‐year OS (NACRT vs non‐NACRT: 75.42% vs 72.76%; P = 0.594) and 5‐year DFS (NACRT vs non‐NACRT: 74.25% vs 70.13%; P = 0.224) were comparable between NACRT and non‐NACRT, whereas the 5‐year DFS rate was higher in the NACRT group when only stage IIIb/IIIc patients were considered (NACRT vs. non‐NACRT: 74.79% vs. 62.29%; P = 0.056). In the NACRT group of 185 patients, those with pCR/stage I (vs stage II/stage III disease) or TRG3/TRG4 disease (vs TRG0/TRG1/TRG2) had significantly better prognosis.ConclusionNACRT might provide survival benefit in patients with stage IIIb/IIIc locally advanced rectal cancer.