Assessment of a Watch-and-Wait Strategy for Rectal Cancer in Patients With a Complete Response After Neoadjuvant Therapy

作者：Jesse Joshua Smith, Paul D. Strombom, Oliver S. Chow, Campbell S.D. Roxburgh, Patricio B. Lynn, Anne A. Eaton, Maria Widmar, Karuna Ganesh, Rona D. Yaeger, Andrea Cercek, Martin R. Weiser, Garrett Michael Nash, José G. Guillem, Larissa K. F. Temple, Sree Bhavani Chalasani, James Louis Fuqua, Iva Petkovska, Abraham Jing-Ching Wu, Marsha Reyngold, Efsevia Vakiani, Jinru Shia, Neil Howard Segal, James D. Shand Smith, Christopher H. Crane, Marc Jeffrey Gollub, Mithat Gönen, Leonard B. Saltz, Julio García‐Aguilar, Philip B. Paty · 发表于：JAMA Oncology · 年份：2019 · DOI：10.1001/jamaoncol.2018.5896 · 被引用次数：607 · 研究领域：Colorectal Cancer Surgical Treatments、Prostate Cancer Diagnosis and Treatment、Colorectal and Anal Carcinomas

IMPORTANCE: The watch-and-wait (WW) strategy aims to spare patients with rectal cancer unnecessary resection. OBJECTIVE: To analyze the outcomes of WW among patients with rectal cancer who had a clinical complete response to neoadjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series analysis conducted at a comprehensive cancer center in New York included patients who received a diagnosis of rectal adenocarcinoma between January 1, 2006, and January 31, 2015. The median follow-up was 43 months. Data analyses were conducted from June 1, 2016, to October 1, 2018. EXPOSURES: Patients had a clinical complete response after completing neoadjuvant therapy and agreed to a WW strategy of active surveillance and possible salvage surgery (n = 113), or patients underwent total mesorectal excision and were found to have a pathologic complete response (pCR) at resection (n = 136). MAIN OUTCOMES AND MEASURES: Kaplan-Meier estimates were used for analyses of local regrowth and 5-year rates of overall survival, disease-free survival, and disease-specific survival. RESULTS: Compared with the 136 patients in the pCR group, the 113 patients in the WW group were older (median [range], 67.2 [32.1-90.9] vs 57.3 [25.0-87.9] years, P < .001) with cancers closer to the anal verge (median [range] height from anal verge, 5.5 [0.0-15.0] vs 7.0 [0.0-13.0] cm). All 22 local regrowths in the WW group were detected on routine surveillance and treated by salvage surgery (20 total m...