Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD).
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
16 05 2023
16 05 2023
Historique:
received:
28
10
2022
revised:
13
01
2023
accepted:
05
02
2023
medline:
17
5
2023
pubmed:
28
3
2023
entrez:
27
3
2023
Statut:
ppublish
Résumé
In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment. This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality. A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI. Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.
Sections du résumé
BACKGROUND
In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment.
METHODS
This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality.
RESULTS
A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI.
CONCLUSION
Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.
Identifiants
pubmed: 36972213
pii: 7087121
doi: 10.1093/bjs/znad051
pmc: PMC10364523
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
676-684Subventions
Organisme : European Union's Horizon 2020
ID : 857894
Investigateurs
M Aghili
(M)
A Keshvari
(A)
M K Nouritaromlou
(MK)
M Ahlberg
(M)
S Kordnejad
(S)
A Aleinikov
(A)
A Dulskas
(A)
O Asoğlu
(O)
H Tokmak
(H)
R G Barroca
(RG)
A F Caiado
(AF)
I A L Rosa
(IAL)
S O Breukink
(SO)
M F Coraglio
(MF)
S Iseas
(S)
B Creaven
(B)
D C Winter
(DC)
A Zaborowski
(A)
C Cunningham
(C)
E Gregory
(E)
P A Custers
(PA)
B M Geubels
(BM)
L DeBrun
(L)
A D'Hoore
(A)
G Dimofte
(G)
K Fechner
(K)
K Matzel
(K)
L Fernandez
(L)
A I Herrando
(AI)
P Vieira
(P)
W B Gaertner
(WB)
R D Madoff
(RD)
J P Gerard
(JP)
F Jacquinot
(F)
R Schiappa
(R)
S Gollins
(S)
M Gonzalez
(M)
C A Vaccaro
(CA)
A Habr-Gama
(A)
Julião G P São
(JGP)
F A Holman
(FA)
R Hompes
(R)
W Lameris
(W)
S H J Ketelaers
(SHJ)
H J T Rutten
(HJT)
K Leitner
(K)
C Mazzarisi
(C)
L Malcomson
(L)
S T O'Dwyer
(ST)
M Saunders
(M)
A Maroli
(A)
P Mitchell
(P)
S Murad-Regadas
(S)
A Pairola
(A)
Salazar I Pedraza
(SI)
Loria F Sanchez
(LF)
A J Pennings
(AJ)
A Spinelli
(A)
Myint A Sun
(MA)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
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