Local Regrowth and the Risk of Distant Metastases Among Patients Undergoing Watch-and-Wait for Rectal Cancer: What Is the Best Control Group? Multicenter Retrospective Study
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Citações na Scopus
1
Tipo de produção
article
Data de publicação
2024
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
JULIAO, Guilherme Pagin Sao
FERNANDEZ, Laura M.
VAILATI, Bruna Borba
AZEVEDO, Jose M.
SANTIAGO, Ines A.
PARES, Oriol
PARVAIZ, Amjad
VENDRELY, Veronique
RULLIER, Anne
Citação
DISEASES OF THE COLON & RECTUM, v.67, n.1, p.73-81, 2024
Resumo
BACKGROUND:A proportion of rectal cancer patients who achieve a clinical complete response may develop local regrowth. Although salvage appears to provide appropriate local control, the risk of distant metastases is less known.OBJECTIVE:To compare the risk of distant metastases between patients who achieve a clinical complete response (watch-and-wait strategy) and subsequent local regrowth and patients managed by surgery after chemoradiation.DESIGN:Retrospective multicenter cohort study.SETTINGS:This study used data of patients from 3 institutions who were treated between 1993 and 2019.PATIENTS:Patients with initial clinical complete response (after neoadjuvant therapy) followed by local regrowth and patients with near-complete pathological response (<= 10%) after straightforward surgery after chemoradiation were included.MAIN OUTCOME MEASURES:Univariate and multivariate analyses were performed to identify risk factors for distant metastases. Kaplan-Meier curves were created (log-rank test) to compare survival outcomes. Analyses were performed using time zero as last day of radiation therapy or as date of salvage resection in the local regrowth group.RESULTS:Twenty-one of 79 patients with local regrowth developed distant metastases, whereas only 10 of 74 after upfront total mesorectal excision following neoadjuvant chemoradiation therapy (p = 0.04). Local regrowth and final pathology (ypT3-4) were the only independent risk factors associated with distant metastases. When using date of salvage resection as time zero, distant metastases-free survival rates were significantly inferior for patients with local regrowth (70% vs 86%; p = 0.01).LIMITATIONS:Small number of patients, many neoadjuvant therapies, and selection bias.CONCLUSIONS:Patients undergoing watch-and-wait strategy who develop local regrowth are at higher risk for development of distant metastases compared to patients with near-complete pathological response managed by upfront surgery after chemoradiation. See Video Abstract
Palavras-chave
Local regrowth, Near-complete response, Rectal cancer, Systemic relapse, Watch and wait
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