直肠癌新辅助放化疗后等待观察策略疗效分析

doi:10.3760/cma.j.cn113030-20210819-00315

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Abstract Objective To compare the outcomes of watch&wait (W&W) strategy in patients with locally advanced rectal cancer who achieved complete clinical response (cCR) after neoadjuvant therapy, with those who obtained pathological complete response (pCR) after total mesorectal excision (TME). Methods This is a retrospective cohort analysis study. Patients histologically proven with locally advanced rectal adenocarcinoma (stage Ⅱ-Ⅲ) who had received neoadjuvant chemotherapy were eligible between January 2014 and December 2019. In whom we included patients who had cCR offered management with W&W strategy after completing neoadjuvant therapy and follow-up ≥1 year (W&W group),and patients who did not have cCR but pCR after TME (pCR group). The primary endpoints were 3-year and 5-year overall survival (OS), colostomy-free survival (CFS), disease-free survival (DFS), non-local regrowth disease-free survival (NR-DFS), and organ preservation rate. Kaplan-Meier analysis was used for survival analysis and log-rank test was performed. For comparative analysis, we also derived one-to-one paired cohorts of W&W versus pCR using propensity-score matching (PSM). Results A total of 118 patients were enrolled,49 of whom had cCR and managed by W&W, 69had pCR, with a median follow-up period of 49.5 months (12.1-79.9 months). No difference was observed in the 3-year OS (97.1% vs. 96.7%) and 5-year OS (93.8% vs. 90.9%, P=0.696) between the W&W and pCR groups. Patients managed by W&W had significantly better 3-year and 5-year CFS (89.1% vs. 43.5%, P<0.001), better 3-year DFS (83.6% vs. 97.0%) and 5-year DFS (83.6% vs. 91.2%, P=0.047) compared with those achieving pCR. The 3-year NR-DFS (95.9% vs. 97.0%) and 5-year NR-DFS (92.8% vs. 97.0%, P=0.407) did not significantly differ between the W&W and pCR groups. Local regeneration occurred in six cases, and 87.7% of patients had successful rectum preservation in the W&W group. In the PSM analysis (34 patients in each group), absolutely better CFS (90.1% vs. 26.5%, P<0.001) was noted in the W&W group. A median interval of 17.5 weeks was observed for achieving cCR, while only 23.9% of patients achieved cCR within 5 to 12 weeks from radiation completion. Patients with short-course sequential chemoradiotherapy achieved cCR significantly later when compared with those with long-course concurrent chemoradiotherapy (19.0 vs. 9.8 weeks, P<0.001). Conclusions The oncological outcomes of W&W strategy in patients with locally advanced rectal cancer are safe and effective, significantly improving the quality of life. Longer interval for cCR evaluation may improve rectal organ preservation rate.

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	Articles by authors
	Zhao Ying
	Tang Yuan
	Liu Wenyang
	Li Ning
	Chen Silin
	Shi Jinming
	Ma Huiying
	Zeng Qiang
	Song Yongwen
	Wang Shulian
	Liu Yueping
	Fang Hui
	Lu Ningning
	Tang Yu
	Qi Shunan
	Yang Yong
	Chen Bo
	Li Yexiong
	Jin Jing

Key words： Rectal neoplasm, locally advanced Watch and wait Total mesorectal excision Complete clinical response Organ preservation

Received: 19 August 2021

Corresponding Authors: Jin Jing, Email:jinjing@cicams.ac.cn

Cite this article:

Zhao Ying,Tang Yuan,Liu Wenyang et al. Long-term outcomes of watch&wait (W&W) after neoadjuvant treatment in patients with rectal cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(3): 253-259.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210819-00315 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I3/253

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492.
[2] Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3):145-164. DOI:10.3322/caac.21601.
[3] Fokas E, Ströbel P, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy as a prognostic factor and individual-level surrogate for disease-free survival in rectal cancer[J]. J Natl Cancer Inst, 2017, 109(12). DOI:10.1093/jnci/djx095.
[4] Karagkounis G, Thai L, Mace AG, et al. Prognostic implications of pathological response to neoadjuvant chemoradiation in pathologic stage Ⅲ rectal cancer[J]. Ann Surg, 2019, 269(6):1117-1123. DOI:10.1097/SLA.0000000000002719.
[5] van der Valk M, Hilling DE, Bastiaannet E, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the international watch&wait database (IWWD):an international multicentre registry study[J]. Lancet, 2018, 391(10139):2537-2545. DOI:10.1016/S0140-6736(18)31078-X.
[6] Garcia-Aguilar J, Patil S, Kim JK, et al. Preliminary results of the organ preservation of rectal adenocarcinoma (OPRA) trial[J]. J Clin Oncol, 2020, 38(15_suppl):4008. DOI:10.1200/JCO.2020.38.15_suppl.4008.
[7] Maas M, Lambregts DM, Nelemans PJ, et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI:selection for organ-saving treatment[J]. Ann Surg Oncol, 2015, 22(12):3873-3880. DOI:10.1245/s10434-015-4687-9.
[8] Smith JJ, Chow OS, Gollub MJ, et al. Organ preservation in rectal adenocarcinoma:a phase Ⅱ randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management[J]. BMC Cancer, 2015, 15:767. DOI:10.1186/s12885-015-1632-z.
[9] Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0distal rectal cancer following chemoradiation therapy:long-term results[J]. Ann Surg, 2004, 240(4):711-717;discussion 717-718. DOI:10.1097/01.sla.0000141194.27992.32.
[10] Maas M, Beets-Tan RG, Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer[J]. J Clin Oncol, 2011, 29(35):4633-4640. DOI:10.1200/JCO.2011.37.7176.
[11] Smith JD, Ruby JA, Goodman KA, et al. Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy[J]. Ann Surg, 2012, 256(6):965-972. DOI:10.1097/SLA.0b013e3182759f1c.
[12] Smith JJ, Chow OS, Eaton A, et al. Organ preservation in patients with rectal cancer with clinical complete response after neoadjuvant therapy[J]. J Clin Oncol, 2015, 33:509. DOI:10.1200/jco.2015.33.3_suppl.509.
[13] Habr-Gama A, Gama-Rodrigues J, São Julião GP, et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation:impact of salvage therapy on local disease control[J]. Int J Radiat Oncol Biol Phys, 2014, 88(4):822-828. DOI:10.1016/j.ijrobp.2013.12.012.
[14] Martens MH, Maas M, Heijnen LA, et al. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer[J]. J Natl Cancer Inst, 2016, 108(12). DOI:10.1093/jnci/djw171.
[15] van der Sande ME, Figueiredo N, Beets GL. Management and outcome of local regrowths in a watch-and-wait prospective cohort for complete responses in rectal cancer[J]. Ann Surg, 2020, 274(6):e1056-e1062. DOI:10.1097/SLA.0000000000003738.
[16] Renehan AG, Malcomson L, Emsley R, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project):a propensity-score matched cohort analysis[J]. Lancet Oncol, 2016, 17(2):174-183. DOI:10.1016/S1470-2045(15)00467-2.
[17] Dossa F, Chesney TR, Acuna SA, et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation:a systematic review and meta-analysis[J]. Lancet Gastroent Hepat, 2017, 2(7):501-513. DOI:10.1016/S2468-1253(17)30074-2.
[18] Ellis CT, Dusetzina SB, Sanoff H, et al. Long-term survival after chemoradiotherapy without surgery for rectal adenocarcinoma:A word of caution[J]. JAMA Oncol, 2017, 3(1):123-125. DOI:10.1001/jamaoncol.2016.3424.
[19] Fernandez LM, São Julião GP, Figueiredo NL, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the international watch&wait database:a retrospective, international, multicentre registry study[J]. Lancet Oncol, 2021, 22(1):43-50. DOI:10.1016/S1470-2045(20)30557-X.
[20] Smith JJ, Strombom P, Chow OS, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy[J]. JAMA Oncol, 2019, 5(4):e185896. DOI:10.1001/jamaoncol.2018.5896.
[21] Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23):a multicentre, randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2021, 22(5):702-715. DOI:10.1016/S1470-2045(21)00079-6.
[22] Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO):a randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2021, 22(1):29-42. DOI:10.1016/S1470-2045(20)30555-6.
[23] Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer:ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4):iv263. DOI:10.1093/annonc/mdy161.
[24] National Committee on Computer Network. NCCN clinical practice guidelines in oncology:rectal cancer. Version 3.2019[EB/OL][2019-08-10].http://guide.medlive.cn/.
[25] Mei SW, Liu Z, Wei FZ, et al. Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients[J]. World J Gastroenterol, 2020, 26(31):4624-4638. DOI:10.3748/wjg.v26.i31.4624.
[26] Habr-Gama A, São Julião GP, Fernandez LM, et al. Achieving a complete clinical response after neoadjuvant chemoradiation that does not require surgical resection:it may take longer than you think![J]. Dis Colon Rectum, 2019, 62(7):802-808. DOI:10.1097/DCR.0000000000001338.
[27] Hupkens B, Maas M, Martens MH, et al. Organ preservation in rectal cancer after chemoradiation:should we extend the observation period in patients with a clinical near-complete response?[J]. Ann Surg Oncol, 2018, 25(1):197-203. DOI:10.1245/s10434-017-6213-8.