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BIBTEX RIS

Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer

2024; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1200/jco.24.00405

1527-7755

Laura M. Fernández, Guilherme Pagin São Julião, Carlos Cerdán Santacruz, Andrew G. Renehan, Óscar Cano-Valderrama, Geerard L. Beets, José Azevedo, Blas Flor‐Lorente, Rocío Santos Rancaño, Sebastiano Biondo, Eloy Espín, Bruna Borba Vailati, Per J. Nilsson, Anna Martling, Cornelis J.�H. van de Velde, Amjad Parvaiz, Angelita Habr‐Gama, Rodrigo Oliva Perez, Francisco Blanco‐Antona, Elena Yagüe Martín, Jesús Cifuentes Tébar, Alberto Parajó Calvo, Natalia Uribe Quintana, Mauricio García Alonso, Jesús Pedro Paredes Cotoré, Ana Benítez Riesco, Noelia Ibáñez, C. Polanco Sánchez, Didac Ribé Serrat, Guillermo Ais, Marta Jiménez Toscano, A V Calpe Climent, Mónica Reig Pérez, José Enrique Sierra Grañón, J. Mateo, Sebastiano Biondo, Ana Gálvez Saldaña, Carlos Álvarez Laso, Ignacio Aguirre Allende, Daniel Huerga Álvarez, R Coll, Wilson Manuel Sánchez Bautista, M. Sánchez, Paula Dujovne, Ignasi Camps, Marta Cuadrado, Olga Maseda Díaz, Nieves Jaén Sánchez, María del Coral de la Vega Olías, Eloy Espin Basan, Miquel Kraft, Mahdi Aghili, Marion Arnold, Oktar Asoğlu, Krzysztof Bujko, A Caiado, Carlos Carvalho, Roland Chautems, Claudio Coco, Giuditta Chiloiro, Chris Cunningham, Petra A. Custers, Hester E. Haak, André D’Hoore, Gabriel Dimofte, Peirong Ding, S. Duff, Natália Mariana Felício, Nuno Figueiredo, Wolfgang B. Gaertner, Jean‐Pierre Gérard, Joaquim Gama‐Rodrigues, Barbara M. Geubels, E Gregory, Isidora Salazar, Alberto Ignacio Herrando, J. Hill, Zahirul Huq, F Jacquinot, Anders Jakobsen, Lars Henrik Jensen, Derek A. Jones, Amir Keshvari, Stijn H. J. Ketelaers, Uzair Ali Khan, RS Kushwaha, Shahrzad Kordnejad, Katharina Leitner, Robert D. Madoff, Lee Malcomson, Anna Martling, Katja Fechner, Klaus E. Matzel, Claudia Mazzarisi, Elma Meershoek, Jarno Melenhorst, M K Nouritaromlou, Goffredo Paolo, Alexander Pennings, Sthela Maria Murad‐Regadas, Rafael Vaz Pandini, Koen Peeters, Shyamji Rawat, David M. Richards, Isadora Rosa, Gustavo Rossi, H.J.T. Rutten, Fernando Sánchez Loria, Inês Santiago, K.H. Siddiqui, Mamoon Solkar, Arthur Sun Myint, Karen Telford, Jing Tang, Sofieke Temmink, Handan Tokmak, Carlos Vaccaro, Sarah V. Ward, Albert Wolthuis, Lameris Wytze, Jiehai Yu, Zhen Zhang,

Colorectal Cancer Treatments and Studies

PURPOSE Organ preservation has become an attractive alternative to surgery (total mesorectal excision [TME]) among patients with rectal cancer after neoadjuvant therapy who achieve a clinical complete response (cCR). Nearly 30% of these patients will develop local regrowth (LR). Although salvage resection is frequently feasible, there may be an increased risk for development of subsequent distant metastases (DM). The aim of this study is to compare the risk of DM between patients with LR after Watch and Wait (WW) and patients with near-complete pathologic response (nPCR) managed by TME at the time of reassessment of response. METHODS Data from patients enrolled in the International Watch & Wait Database (IWWD) with cCR managed by WW and subsequent LR were compared with patients managed by TME (with ≤10% cancer cells—nPCR) from the Spanish Rectal Cancer Project (VIKINGO project). The primary end point was DM-free survival at 3 years from decision to WW or TME. The secondary end point was possible risk factors associated with DM. RESULTS Five hundred and eight patients with LR were compared with 893 patients with near-complete response after TME. Overall, DM rate was significantly higher among LRs (22.8% v 10.2%; P ≤ .001). Independent risk factors for DM included LR ( v TME at reassessment; P = .001), ypT3-4 status ( P = .016), and ypN+ status ( P = .001) at the time of surgery. 3-year DM-free survival was significantly worse for patients with LR (75% v 87%; P = .001). When stratified for pathologic stage, patients with LR did significantly worse through all stages ( P ≤ .009). CONCLUSION Patients with LR appear to have a higher risk for subsequent DM development than patients with nPCR managed by TME at restaging irrespective of final pathology. Leaving the primary undetectable tumor in situ until development of LR may result in worse oncologic outcomes.