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

Autor:	Fernandez LM; Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal., São Julião GP; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.; Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil., Santacruz CC; Department of Surgery, Hospital de la Princesa, Madrid, Spain., Renehan AG; Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, School of Medical Sciences, University of Manchester, Manchester, United Kingdom.; Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom., Cano-Valderrama O; Department of Surgery, Hospital de la Princesa, Madrid, Spain., Beets GL; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands., Azevedo J; Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal., Lorente BF; Department of Surgery, Hospital La Fé, Valencia, Spain., Rancaño RS; Department of Surgery, Hospital Clinico San Carlos de Madrid, Madrid, Spain., Biondo S; Colorectal Surgery Unit, Department of Surgery, Hospital Valle de Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain., Espin-Basany E; Colorectal Surgery Unit, Department of Surgery, Hospital Valle de Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain., Vailati BB; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.; Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil., Nilsson PJ; Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden., Martling A; Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden., Van De Velde CJH; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Parvaiz A; Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal., Habr-Gama A; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil., Perez RO; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.; Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2024 Oct 28, pp. JCO2400405. Date of Electronic Publication: 2024 Oct 28.
DOI:	10.1200/JCO.24.00405
Abstrakt:	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.
Databáze:	MEDLINE
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