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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

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    Authors
    Fernandez, L. M.
    São Julião, G. P.
    Renehan, Andrew G
    Beets, G. L.
    Papoila, A. L.
    Vailati, B. B.
    Bahadoer, R. R.
    Kranenbarg, E. M.
    Roodvoets, A. G. H.
    Figueiredo, N. L.
    Van De Velde, C. J. H.
    Habr-Gama, A.
    Perez, R. O.
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    Affiliation
    Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portuga
    Issue Date
    2023
    
    Metadata
    Show full item record
    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.
    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.
    Journal
    Diseases of the Colon and Rectum
    URI
    http://hdl.handle.net/10541/625913
    DOI
    10.1097/dcr.0000000000002494
    PubMed ID
    36515514
    Additional Links
    https://dx.doi.org/10.1097/dcr.0000000000002494
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1097/dcr.0000000000002494
    Scopus Count
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    All Christie Publications

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