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

Fernandez LM, São Julião GP, Santacruz CC, Renehan AG, Cano-Valderrama O, Beets GL, Azevedo J, Lorente BF, Rancaño RS, Biondo S, Espin-Basany E, Vailati BB, Nilsson PJ, Martling A, Van De Velde CJ, Parvaiz A, Habr-Gama A, Perez RO, Antona FB, Martín EY, Tébar JC, Calvo AP, Quintana NU, Alonso MG, Cotoré JP, Riesco AB, Cánovas NI, Sanchez CM, Ribe i Serrat D, Ais G, Toscano MJ, Climent A, Pérez MR, Grañón JES, Mateo J, Biondo S, Saldaña AG, Laso CA, Allende IA, Alvarez DH, Coll RF, Sánchez Bautista WM, Sánchez MTT, Dujovne P, Camps I, Cuadrado M, Díaz OM, Sánchez N, del Coral de la Vega Olías M, Basan EE, Carre MK, Aghili M, Arnold M, Asoglu O, Bujko K, Caiado A, Carvalho C, Chautems R, Coco C, Chiloiro G, Cunningham C, Custers P, Haak H, D’Hoore A, Dimofte G, Ding P, Duff S, Felicio N, Figueiredo N, Gaertner W, Gérard JP, Gama-Rodrigues J, Geubels B, Gregory E, Salazar IP, Herrando I, Hill J, Huq Z, Jacquinot F, Jakobsen A, Jensen LH, Jones D, Keshvari A, Ketelaers SH, Khan U, Kushwaha R, Kordnejad S, Leitner K, Madoff R, Malcomson L, Martling A, Fechner K, Matzel K, Mazzarisi C, Meershoek E, Melenhorst J, Nouritaromlou M, Paolo G, Pennings A, Murad-Regadas SM, Pandini R, Peeters KC, Rawat S, Richards D, Rosa I, Rossi G, Rutten HJ, Loria FS, Santiago I, Siddiqui KH, Solkar MH, Myint AS, Telford K, Tang J, Temmink S, Tokmak H, Vaccaro CA, Ward S, Wolthuis AM, Wytze L, Yu J, Zhang Z (2024)

Publication Language: English

Publication Type: Journal article

Publication year: 2024

Journal

Book Volume: 43

Pages Range: 1663-1672

Journal Issue: 14

DOI: 10.1200/JCO.24.00405

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 5 .001), ypT3-4 status (P 5 .016), and ypN1 status (P 5 .001) at the time of surgery. 3-year DM-free survival was significantly worse for patients with LR (75% v 87%; P 5 .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.

Authors with CRIS profile

Involved external institutions

Complejo Hospitalario de Salamanca / Complejo Asistencial Universitario de Salamanca Spain (ES) Complejo Hospitalario Universitario de Albacete Spain (ES) Complejo Hospitalario de Ourense (CHUO) Spain (ES) Hospital Clínico Universitario de Valencia Spain (ES) Donostia University Hospital / Donostia Unibertsitate Ospitalea Spain (ES) Hospital General De Segovia Spain (ES) Bellvitge University Hospital / Hospital Universitari de Bellvitge Spain (ES) Hospital Universitario de Jerez Spain (ES) Hospital Universitario Dr. Peset Aleixandre Spain (ES) Imam Khomeini Hospital / بیمارستان امام خمینی تهران Iran, Islamic Republic of (IR) Südtiroler Sanitätsbetrieb (SABES-ASDAA) Italy (IT) Christie NHS Foundation Trust United Kingdom (GB) Maastricht University Medical Center (UMC+) Netherlands (NL) University of Minnesota (UMN) United States (USA) (US) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Leiden University Medical Center Netherlands (NL) Hospital Italiano de Buenos Aires Argentina (AR) Manchester Royal Infirmary United Kingdom (GB) Hospital Asil de Granollers Spain (ES) Champalimaud Foundation / Fundação Champalimaud Portugal (PT) East Cheshire NHS Trust United Kingdom (GB) Tameside Hospital United Kingdom (GB) Health Sciences Research Institute of the “Germans Trias i Pujol” Foundation (IGTP) Spain (ES) Povisa Hospital Spain (ES) Sun Yat-sen University Cancer Center (SYSUCC) / 中山大学肿瘤防治中心 China (CN) Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI / NKI-AVL) Netherlands (NL) Hospital Clínico San Carlos Spain (ES) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) Hospital Universitario de La Princesa Spain (ES) Hospital del Mar Spain (ES) Hospital Universitario Puerto Real Spain (ES) Centre Antoine Lacassagne (UNICANCER) France (FR) Hospital de la Santa Creu i Sant Pau Spain (ES) Oxford University Hospitals NHS Foundation Trust United Kingdom (GB) Hospital Alemão Oswaldo Cruz Brazil (BR) Maastricht University Netherlands (NL) North Manchester General Hospital United Kingdom (GB) Instituto Português de Oncologia Francisco Gentil (IPO) / Portuguese Oncology Institute Portugal (PT) Hospital Universitario y Politécnico de La Fe Spain (ES) Autonomous University of Barcelona (UAB) / Universitat Autònoma de Barcelona Spain (ES) Hospital Universitari Arnau de Vilanova (HUAV) Spain (ES) Universidade Federal do Ceará (UCF) Brazil (BR) Hospital Universitario Araba Spain (ES) Manchester University NHS Foundation Trust (MFT) United Kingdom (GB) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie Poland (PL) University of Manchester United Kingdom (GB) Karolinska Institute Sweden (SE) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Complejo Hospitalario Torrecárdenas Spain (ES) Grigore T. Popa University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie "Grigore T. Popa" (UMF Iași) Romania (RO) Royal Oldham Hospital United Kingdom (GB) Fudan University Shanghai Cancer Center (FUSCC) China (CN) Hospital de Cabueñes Spain (ES) Hospital Universitario Fundación Alcorcón (HUFA) Spain (ES) Hospital Lusíadas Lisboa Portugal (PT) Hospital Israelita Albert Einstein Brazil (BR) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) Clatterbridge Cancer Centre United Kingdom (GB) Réseau Hospitalier Neuchâtelois Switzerland (CH) Hospital Universitario Miguel Servet Spain (ES) Hospital Universitari Dr. Josep Trueta Spain (ES) Hospital Clínico Universitario Virgen de la Arrixaca Spain (ES) Complejo Hospitalario Universitario de Santiago de Compostela Spain (ES) Hospital Universitario de Fuenlabrada Spain (ES)

How to cite

APA:

Fernandez, L.M., São Julião, G.P., Santacruz, C.C., Renehan, A.G., Cano-Valderrama, O., Beets, G.L.,... Zhang, Z. (2024). Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer. Journal of Clinical Oncology, 43(14), 1663-1672. https://doi.org/10.1200/JCO.24.00405

MLA:

Fernandez, Laura M., et al. "Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer." Journal of Clinical Oncology 43.14 (2024): 1663-1672.

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