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

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

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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