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  3. Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer.

Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Fernandez LM
  • São Julião GP
  • Santacruz CC
  • Renehan AG
  • Cano-Valderrama O
  • Beets GL
  • Azevedo J
  • Rancaño RS
  • Biondo S
  • Espin-Basany E
  • Vailati BB
  • Nilsson PJ
  • Martling A
  • Van De Velde CJH
  • Parvaiz A
  • Habr-Gama A
  • Perez RO
  • International Watch & Wait Database Consortium (IWWD) and the Spanish Rectal Ca
  • International Watch & Wait Database Consortium (IWWD) & Spanish Rectal Cancer V

Grupos

Abstract

PURPOSE: Organ preservation has become an attractive alternative to surgery (total mesorectal excision [TME]) among patients with rectal cancer after neoadjuvant therapy who achieve a clinical complete response (cCR). Nearly 30% of these patients will develop local regrowth (LR). Although salvage resection is frequently feasible, there may be an increased risk for development of subsequent distant metastases (DM). The aim of this study is to compare the risk of DM between patients with LR after Watch and Wait (WW) and patients with near-complete pathologic response (nPCR) managed by TME at the time of reassessment of response. METHODS: Data from patients enrolled in the International Watch & Wait Database (IWWD) with cCR managed by WW and subsequent LR were compared with patients managed by TME (with =10% cancer cells-nPCR) from the Spanish Rectal Cancer Project (VIKINGO project). The primary end point was DM-free survival at 3 years from decision to WW or TME. The secondary end point was possible risk factors associated with DM. RESULTS: Five hundred and eight patients with LR were compared with 893 patients with near-complete response after TME. Overall, DM rate was significantly higher among LRs (22.8% v 10.2%; P = .001). Independent risk factors for DM included LR (v TME at reassessment; P = .001), ypT3-4 status (P = .016), and ypN+ status (P = .001) at the time of surgery. 3-year DM-free survival was significantly worse for patients with LR (75% v 87%; P = .001). When stratified for pathologic stage, patients with LR did significantly worse through all stages (P = .009). CONCLUSION: Patients with LR appear to have a higher risk for subsequent DM development than patients with nPCR managed by TME at restaging irrespective of final pathology. Leaving the primary undetectable tumor in situ until development of LR may result in worse oncologic outcomes.

Datos de la publicación

ISSN/ISSNe:
0732-183X, 1527-7755

JOURNAL OF CLINICAL ONCOLOGY  AMER SOC CLINICAL ONCOLOGY

Tipo:
Article
Páginas:
2400405-2400405
Factor de Impacto:
9,378 SCImago ℠
Cuartil:
Q1 SCImago ℠

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