Correlation Between Grade of Clinical Response to Neoadjuvant Therapy for Rectal Cancer and Oncologic Outcomes in the Era of Watch-and-Wait

被引：2

作者：

Rosen, Roni ^{[1
]}

Bercz, Aron ^{[1
]}

Omer, Dana ^{[1
]}

Verheij, Floris ^{[1
]}

Williams, Hannah ^{[1
]}

Malekzadeh, Parisa ^{[1
]}

Kong, Danielle ^{[1
]}

Quezada-Diaz, Felipe ^{[1
]}

Wei, Iris ^{[1
]}

Widmar, Maria ^{[1
]}

Karagkounis, Georgios ^{[1
]}

Roth O'Brien, Diana ^{[2
]}

Hajj, Carla ^{[2
]}

Crane, Christopher ^{[2
]}

Gu, Ping ^{[3
]}

Segal, Neil ^{[3
]}

Shcherba, Marina ^{[3
]}

Ganesh, Karuna ^{[3
]}

Yaeger, Rona ^{[3
]}

Pappou, Emmanouil ^{[1
]}

Romesser, Paul ^{[2
]}

Nash, Garrett ^{[1
]}

Saltz, Leonard ^{[3
]}

Cercek, Andrea ^{[3
]}

Weiser, Martin ^{[1
]}

Gonen, Mithat ^{[4
]}

Paty, Philip ^{[1
]}

Garcia-Aguilar, Julio ^{[1
]}

Smith, J. ^{[1
]}

机构：

[1] MEM SLOAN KETTERING CANC CTR, Dept Colon & Rectal Surg, 1275 York Ave, NEW YORK, NY 10065 USA

[2] Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol, New York, NY USA

[3] Mem Sloan Kettering Canc Ctr, Dept Med Oncol, New York, NY USA

[4] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY USA

来源：

DISEASES OF THE COLON & RECTUM | 2025年 / 68卷 / 03期

基金：

美国国家卫生研究院;

关键词：

Near-complete response; Watch-and-wait; INTERNATIONAL WATCH; PREOPERATIVE CHEMORADIOTHERAPY; TUMOR-REGRESSION; CHEMORADIATION;

D O I：

10.1097/DCR.0000000000003538

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND: The watch-and-wait strategy provides an opportunity to pursue nonoperative management in rectal cancer patients with clinical complete response after neoadjuvant therapy. The management of those with near-complete response remains controversial. OBJECTIVE: We assessed the oncologic outcomes of patients managed by watch-and-wait versus total mesorectal excision according to clinical response to neoadjuvant therapy. DESIGN: Retrospective cohort study. SETTINGS: Comprehensive cancer center in New York. PATIENTS: Patients with rectal adenocarcinoma diagnosed between January 2006 and December 2020. INTERVENTIONS: A watch-and-wait strategy of active surveillance was offered to patients if they achieved clinical complete response. Salvage surgery was used for watch-and-wait patients with local regrowth. Patients with an incomplete response underwent total mesorectal excision. MAIN OUTCOME MEASURES: Local regrowth rate, organ preservation rate, disease-free survival, and overall survival. RESULTS: Patients with rectal adenocarcinoma (n = 1230) were divided into 3 response cohorts-incomplete (n = 646), near-complete (n = 189), and complete (n = 395). Eighty-one patients (43%) in the near-complete group and 351 patients (89%) in the complete group entered watch-and-wait. Three-year local regrowth rates were 40% and 24% in the near-complete and complete response cohorts, respectively. The 5-year organ preservation rate was 53% in near-complete responders and 73% in complete responders. Five-year disease-free survival increased with greater clinical response to neoadjuvant therapy, with intermediate outcomes noted for patients with a near-complete (73%) compared to complete (82%) or incomplete (68%) response. Overall survival at 5 years was similar between the 3 cohorts (complete 90%, near-complete 86%, and incomplete 85%). LIMITATIONS: Retrospective nature. CONCLUSIONS: Greater clinical response to neoadjuvant therapy is associated with improved oncologic outcomes. Near-complete responders may avoid surgery and still achieve high organ preservation rates yet experience greater local regrowth rates than clinical complete response patients. Ongoing prospective trials integrating watch-and-wait after complete response as determined by uniform criteria will bolster the work to help treating physicians better select patients who qualify for active surveillance.

引用

页码：300 / 307

页数：8

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