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Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)
Background
In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment.
Methods
This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality.
Results
A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later...
Show moreBackground
In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment.
Methods
This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality.
Results
A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI.
Conclusion
Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.
Show less- All authors
- Temmink, S.J.D.; Peeters, K.C.M.J.; Bahadoer, R.R.; Kranenbarg, E.M.K.; Roodvoets, A.G.H.; Melenhorst, J.; Burger, J.W.A.; Wolthuis, A.; Renehan, A.G.; Figueiredo, N.L.; Pares, O.; Martling, A.; Perez, R.O.; Beets, G.L.; Velde, C.J.H. van de; Nilsson, P.J.; Int Watch & Wait Database IWWD
- Date
- 2023-03-27
- Journal
- British Journal of Surgery
- Volume
- 110
- Issue
- 6
- Pages
- 676 - 684