The following is a summary of “Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer,” published in the October 2024 issue of Oncology by Fernandez et al.
Organ preservation after neoadjuvant therapy for rectal cancer has become an engaging alternative to total mesorectal excision (TME) for patients who achieve a complete clinical response (cCR). However, nearly 30% of these patients experience local regrowth (LR), which may increase the risk of distant metastasis (DM).
Researchers conducted a retrospective study comparing the risk of DM between patients with LR after Watch and Wait (WW) and those with near-complete pathologic response (nPCR) managed by TME.
They compared data from patients enrolled in the International Watch & Wait Database (IWWD) with cCR managed by WW and subsequent patients with LR from the Spanish Rectal Cancer Project (VIKINGO project) with nPCR managed by TME. The primary endpoint was DM-free survival at 3 years from decision to WW or TME.
The result showed that the DM rate was significantly higher in patients with LR (22.8% vs. 10.2%; P≤.001). Independent risk factors for DM included LR (vs. TME at reassessment; P=.001), ypT3-4 status (P=.016), and ypN+ status (P=.001), 3-year DM-free survival was notably worse for patients with LR (75% vs. 87%; P=.001), and patients with LR had significantly worse outcomes across all stages (P≤.009).
They concluded that patients with LR after WW have an increased risk of developing DM than those with nPCR managed by TME.
Source: ascopubs.org/doi/10.1200/JCO.24.00405
