"Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study".

Data de publicació: 29/06/2023 Data Ahead of Print: 29/06/2023

Autors de IIS La Fe

Blas Flor Lorente

Autor
Gianluca Pellino

Autor

Autors aliens a IIS La Fe

Cerdan-Santacruz, Carlos
Cano-Valderrama, Oscar
Vigorita, Vicenzo
Antona, Francisco Blanco
Martin, Elena Yague
Tebar, Jesus Cifuentes
Cao, Ines Aldrey
Coltell, Zutoia Balciscueta
Alonso, Mauricio Garcia
Paredes Cotore, Jesus Pedro
Prada Lopez, Borja Luis
Riesco, Ana Benitez
Canovas, Noelia Ibanez
Sanchez, Carmen Martinez
Serrat, Didac Ribe
Conde, Guillermo Ais
Toscano, Marta Jimenez
Aira, Antonio Climent
Perez, Monica Reig
Petit, Nuria Mestres
Espin Basany, Eloy
Carre, Miquel Kraft
Retuerta, Janire Mateo
Saldana, Ana Galvez
Laso, Carlos Alvarez
Allende, Ignacio Aguirre
Alvarez, Daniel Huerga
Cazador, Antonio Codina
Sanchez Bautista, Wilson Manuel
Torres Sanchez, Maria Teresa
Bonito, Alba Correa
Velazquez, Marta Cuadrado
Diaz, Olga Maseda
Fuentes, Nieves Sanchez
Olias, Maria Del Coral de la Vega
Perez, Teresa Perez
Rosciano Paganelli, Jose Gerardo
Lorente, Blas Flor
Valderrama, Oscar Cano
Santos Rancano, Rocio
Teres, Lara Blanco
Santacruz, Carlos Cerdan
Collaborating group for the study of long-term oncologic results of
pathologic complete response in locally advanced rectal cancer patients
Spanish Rectal Cancer Project (Vikingo)

Grups d'Investigació

Cirugía digestiva y Cuidados perioperatorios

Leader

Matteo Frasson

Abstract

BACKGROUND: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce. METHODS: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival. RESULTS: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p=0.008) and elevated CEA levels (HR=1.9, 95% CI 1.0-3.7, p=0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p<0.001) and ASA III-IV (HR=2.0; 95%-CI 1.4-2.9; p<0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%. CONCLUSIONS: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term.