ACCORD study: a national multi-centre study of the watch and wait approach in patients with rectal cancer in Aotearoa New Zealand

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery Pub Date : 2025-03-12 DOI:10.1111/ans.19415

STRATA Collaborative

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引用次数: 0

Abstract

Aim

The adoption of a watch and wait (W&W) approach in patients with rectal cancer, and a complete clinical response (cCR) following neoadjuvant therapy, is increasing worldwide. Despite this, pragmatic unbiased outcome data is limited. This study aimed to investigate national outcomes associated with W&W in Aotearoa New Zealand (AoNZ).

Methods

A national retrospective study of patients with adenocarcinoma of the rectum managed with a W&W approach between January 2015 and December 2022 in AoNZ was performed by STRATA, a student and trainee led collaborative network. The Cancer Registry and the New Zealand Ministry of Health National Minimum Data Set were linked to identify patients who had rectal cancer and who were treated with neoadjuvant therapy but not rectal resection. Research teams across 17 AoNZ hospitals then screened these patients for inclusion and data collection.

Results

One thousand five hundred and eighteen patients were screened across 17 hospitals, 133 met inclusion criteria. Median age was 71 years. Median follow-up was 2.2 years. The 2-year cumulative incidence of local regrowth was 18.2% (95% CI 10.7%–25.1%), of which 92% was present in the bowel wall, and 68% underwent surgery, all with curative intent. The 2-year cumulative distant metastasis rate was 8.8% (95% CI 3.0%–14.2%) and the 2-year overall survival was 94.8% (95% CI 90.4%–99.4%).

Conclusion

This nationwide study of a W&W approach has clinical outcomes similar to the international literature. This data will help guide further implementation of a W&W approach in the management of patients with rectal cancer and inform both clinicians and patients.

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ACCORD研究：一项在新西兰奥特罗阿对直肠癌患者采用观察和等待方法的全国性多中心研究。

目的：在直肠癌患者中采用观察和等待（W&W）方法，以及新辅助治疗后的完全临床反应（cCR）在世界范围内越来越多。尽管如此，实用的无偏见结果数据是有限的。本研究旨在调查新西兰Aotearoa （AoNZ）与W&W相关的国家结果。方法：由STRATA（一个由学生和实习生领导的协作网络）对2015年1月至2022年12月在AoNZ采用W&W入路治疗的直肠腺癌患者进行了一项全国性的回顾性研究。癌症登记处和新西兰卫生部国家最低数据集被联系起来，以确定直肠癌患者和接受新辅助治疗但不接受直肠切除术的患者。然后，来自17家AoNZ医院的研究团队对这些患者进行筛选，以纳入和收集数据。结果：17家医院共筛查了1518例患者，其中133例符合纳入标准。中位年龄为71岁。中位随访时间为2.2年。2年累积的局部再生发生率为18.2% (95% CI 10.7%-25.1%)，其中92%存在于肠壁，68%的患者接受了手术，所有患者都有治愈目的。2年累积远处转移率为8.8% (95% CI 3.0%-14.2%)， 2年总生存率为94.8% （95% CI 90.4%-99.4%）。结论：这项关于W&W方法的全国性研究的临床结果与国际文献相似。这些数据将有助于指导在直肠癌患者管理中进一步实施W&W方法，并为临床医生和患者提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.