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. 2023 May 16;110(6):676-684.
doi: 10.1093/bjs/znad051.

Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)

Sofieke J D Temmink  1 , Koen C M J Peeters  2 , Renu R Bahadoer  2 , Elma Meershoek-Klein Kranenbarg  2 , Annet G H Roodvoets  2 , Jarno Melenhorst  3 , Jacobus W A Burger  4 , Albert Wolthuis  5 , Andrew G Renehan  6   7 , Nuno L Figueiredo  8 , Oriol Pares  9 , Anna Martling  1 , Rodrigo O Perez  10   11   12   13 , Geerard L Beets  14   15 , Cornelis J H van de Velde  2 , Per J Nilsson  1 ; International Watch & Wait Database (IWWD) Consortium
Collaborators, Affiliations

Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)

Sofieke J D Temmink et al. Br J Surg. .

Abstract

Background: In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment.

Methods: This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality.

Results: A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI.

Conclusion: Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.

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Figures

Fig. 1
Fig. 1
Study flow diagram IWWD, International Watch & Wait Database; mrTRG, magnetic resonance tumour regression grade.
Fig. 2
Fig. 2
Five-year organ preservation rate since first reassessment for patients with a cCR at first reassessment or later reassessment P = 0.499 (log rank test).
Fig. 3
Fig. 3
Five-year organ preservation, distant metastasis-free survival, and overall survival since first reassessment for near-cCR subgroups based on modality a Organ preservation, b distant metastasis-free survival, and c overall survival. aP = 0.020, bP = 0.095, cP = 0.073 (log rank test).
Fig. 4
Fig. 4
Cumulative incidence rates for competing first events since first reassessment for near-cCR subgroups on MRI, endoscopy, and both modalities a MRI, b endoscopy, and c both modalities.
See this image and copyright information in PMC

Comment in

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