Samuel H Lai, Maria Widmar, John R T Monson, Fergal J Fleming, Arden M Morris, Jon D Vogel
{"title":"直肠癌观察与等待管理：美国直肠癌研究小组 545 名患者的经验。","authors":"Samuel H Lai, Maria Widmar, John R T Monson, Fergal J Fleming, Arden M Morris, Jon D Vogel","doi":"10.1097/DCR.0000000000003586","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The use of a watch and wait management strategy following a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes, on a United States national level, are limited.</p><p><strong>Objective: </strong>To investigate and report on watch & wait management practices and outcomes in the US.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Multicenter.</p><p><strong>Patients: </strong>Stage II or III rectal cancer patients who underwent intentional watch & wait management between January 2015 and August 2022.</p><p><strong>Main outcome measures: </strong>Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall and disease-specific survival.</p><p><strong>Results: </strong>Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant were used in 395 (72%) and 150 (28%) of patients, respectively. Estimated 3-year local regrowth rate was 23.8% (95% CI: 19.1-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs. 3.5%, p < 0.001). Salvage surgery was performed in 74/84 (88%) patients with local regrowth and included rectal resection in 66 (89%), and local excision in 8 (11%). Of 64 salvage resections with known pathology results, 58 (91%) were margin-negative. Overall, 3-year overall survival was 94.8% (95% CI: 90.5 - 97.2%) and 3-year disease specific survival 96.2% (95% Cl 91.8 - 98.2%). Patients with and without local regrowth exhibited 3-year overall survival of 83.6% (95% Cl 68.4 - 91.9%), and 97.7% (95% CI: 93.3 - 99.2%), respectively.</p><p><strong>Limitations: </strong>Retrospective study.</p><p><strong>Conclusion: </strong>This multicenter study indicates that the watch & wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the US. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rectal Cancer Watch & Wait Management: Experience of 545 Patients from the U.S. Rectal Cancer Research Group.\",\"authors\":\"Samuel H Lai, Maria Widmar, John R T Monson, Fergal J Fleming, Arden M Morris, Jon D Vogel\",\"doi\":\"10.1097/DCR.0000000000003586\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The use of a watch and wait management strategy following a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes, on a United States national level, are limited.</p><p><strong>Objective: </strong>To investigate and report on watch & wait management practices and outcomes in the US.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Multicenter.</p><p><strong>Patients: </strong>Stage II or III rectal cancer patients who underwent intentional watch & wait management between January 2015 and August 2022.</p><p><strong>Main outcome measures: </strong>Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall and disease-specific survival.</p><p><strong>Results: </strong>Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant were used in 395 (72%) and 150 (28%) of patients, respectively. Estimated 3-year local regrowth rate was 23.8% (95% CI: 19.1-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs. 3.5%, p < 0.001). Salvage surgery was performed in 74/84 (88%) patients with local regrowth and included rectal resection in 66 (89%), and local excision in 8 (11%). Of 64 salvage resections with known pathology results, 58 (91%) were margin-negative. Overall, 3-year overall survival was 94.8% (95% CI: 90.5 - 97.2%) and 3-year disease specific survival 96.2% (95% Cl 91.8 - 98.2%). Patients with and without local regrowth exhibited 3-year overall survival of 83.6% (95% Cl 68.4 - 91.9%), and 97.7% (95% CI: 93.3 - 99.2%), respectively.</p><p><strong>Limitations: </strong>Retrospective study.</p><p><strong>Conclusion: </strong>This multicenter study indicates that the watch & wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the US. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. 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Rectal Cancer Watch & Wait Management: Experience of 545 Patients from the U.S. Rectal Cancer Research Group.
Background: The use of a watch and wait management strategy following a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes, on a United States national level, are limited.
Objective: To investigate and report on watch & wait management practices and outcomes in the US.
Design: Retrospective study.
Setting: Multicenter.
Patients: Stage II or III rectal cancer patients who underwent intentional watch & wait management between January 2015 and August 2022.
Main outcome measures: Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall and disease-specific survival.
Results: Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant were used in 395 (72%) and 150 (28%) of patients, respectively. Estimated 3-year local regrowth rate was 23.8% (95% CI: 19.1-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs. 3.5%, p < 0.001). Salvage surgery was performed in 74/84 (88%) patients with local regrowth and included rectal resection in 66 (89%), and local excision in 8 (11%). Of 64 salvage resections with known pathology results, 58 (91%) were margin-negative. Overall, 3-year overall survival was 94.8% (95% CI: 90.5 - 97.2%) and 3-year disease specific survival 96.2% (95% Cl 91.8 - 98.2%). Patients with and without local regrowth exhibited 3-year overall survival of 83.6% (95% Cl 68.4 - 91.9%), and 97.7% (95% CI: 93.3 - 99.2%), respectively.
Limitations: Retrospective study.
Conclusion: This multicenter study indicates that the watch & wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the US. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. See Video Abstract.
期刊介绍：
Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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