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The risk of distant metastases in patients with clinical complete response managed by watch and wait after neoadjuvant therapy for rectal cancer: the influence of local regrowth in the International Watch and Wait Database
BACKGROUND:
Nearly 30% of patients with rectal cancer develop local regrowth after initial clinical complete response managed by watch and wait. These patients might be at higher risk for distant metastases.
OBJECTIVE:
This study aimed to investigate risk factors for distant metastases using time-dependent analyses.
DESIGN:
Data from an international watch and wait database were retrospectively reviewed. Cox regression analysis was used to determine risk factors for worse distant metastases-free survival. Conditional survival modeling was used to investigate the impact of risk factors on the development of distant metastases.
SETTING:
Retrospective, multicenter database.
PATIENTS:
A total of 793 patients (47 institutions) with rectal cancer and clinical complete response to neoadjuvant treatment from the International Watch & Wait Database were included.
MAIN OUTCOME MEASURES:
Distant metastases...
Show moreBACKGROUND:
Nearly 30% of patients with rectal cancer develop local regrowth after initial clinical complete response managed by watch and wait. These patients might be at higher risk for distant metastases.
OBJECTIVE:
This study aimed to investigate risk factors for distant metastases using time-dependent analyses.
DESIGN:
Data from an international watch and wait database were retrospectively reviewed. Cox regression analysis was used to determine risk factors for worse distant metastases-free survival. Conditional survival modeling was used to investigate the impact of risk factors on the development of distant metastases.
SETTING:
Retrospective, multicenter database.
PATIENTS:
A total of 793 patients (47 institutions) with rectal cancer and clinical complete response to neoadjuvant treatment from the International Watch & Wait Database were included.
MAIN OUTCOME MEASURES:
Distant metastases-free survival.
RESULTS:
Of the 793 patients managed with watch and wait (median follow-up 55.2 mo)‚ 85 patients (10.7%) had distant metastases. Fifty-one of 85 patients (60%) had local regrowth at any time. Local regrowth was an independent factor associated with worse distant metastases-free survival in the multivariable model. Using conditional estimates, patients with local regrowth without distant metastases for 5 years (from decision to watch and wait) remained at higher risk for development of distant metastases for 1 subsequent year compared to patients without local regrowth (5-year conditional distant metastases-free survival 94.9% vs 98.4%).
LIMITATIONS:
Lack of information on adjuvant chemotherapy, salvage surgery for local regrowth, and heterogeneity of individual surveillance/follow-up strategies used may have affected results.
CONCLUSIONS:
In patients with clinical complete response managed by watch and wait, development of local regrowth at any time is a risk factor for distant metastases. The risk of distant metastases remains higher for 5 years after development of local regrowth.
Show less- All authors
- Fernandez, L.M.; Julio, G.P.S.; Renehan, A.G.; Beets, G.L.; Papoila, A.L.; Vailati, B.B.; Bahadoer, R.R.; Kranenbarg, E.M.K.; Roodvoets, A.G.H.; Figueiredo, N.L.; Velde, C.J.H. van de; Habr-Gama, A.; Perez, R.O.; Int Watch & Wait Database IWWD
- Date
- 2023-01-01
- Journal
- Diseases of the Colon and Rectum
- Volume
- 66
- Issue
- 1
- Pages
- 41 - 49