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
Fernandez, L. M. São Julião, G. P. Beets, G. L. Papoila, A. L. Vailati, B. B. Bahadoer, R. R. Kranenbarg, E. M. Roodvoets, A. G. H. Figueiredo, N. L.
Fernandez, L. M.
São Julião, G. P.
Beets, G. L.
Papoila, A. L.
Vailati, B. B.
Bahadoer, R. R.
Kranenbarg, E. M.
Roodvoets, A. G. H.
Figueiredo, N. L.
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Abstract
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-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. See Video Abstract at http://links.lww.com/DCR/C53.
Description
Date
2023
Publisher
Collections
Keywords
Type
Article
Citation
Fernandez LM, São Julião GP, Renehan AG, Beets GL, Papoila AL, Vailati BB, et al. 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. Diseases of the colon and rectum. 2023 Jan 1;66(1):41-9. PubMed PMID: 36515514. Epub 2022/12/15. eng.