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Cerdán-Santacruz C, Cano-Valderrama Ó, Santos Rancaño R, Terés LB, Vigorita V, Pérez TP, Rosciano Paganelli JG, Paredes Cotoré JP, Carre MK, Flor-Lorente B, Antona FB, Martín EY, Tebar JC, Cao IA, Coltell ZB, Alonso MG, Paredes Cotoré JP, Prada López BL, Riesco AB, Cánovas NI, Sánchez CM, Serrat DR, Conde GA, Toscano MJ, Aira AC, Pérez MR, Petit NM, Espín Basany E, Carré MK, Pellino G, Retuerta JM, Saldaña AG, Laso CÁ, Allende IA, Álvarez DH, Cazador AC, Sánchez Bautista WM, Torres Sánchez MT, Bonito AC, Velázquez MC, Díaz OM, Fuentes NS, Olías MDCDLV, Pérez TP, Rosciano Paganelli JG, Lorente BF, Valderrama ÓC, Santos Rancaño R, Terés LB, Santacruz CC. "Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study". Eur J Surg Oncol 2023; 49:106962. [PMID: 37414628 DOI: 10.1016/j.ejso.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/09/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce. METHODS This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival. RESULTS Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%. CONCLUSIONS The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term.
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Affiliation(s)
| | | | | | - Lara Blanco Terés
- Colorectal Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Vicenzo Vigorita
- Colorectal Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Jesús Pedro Paredes Cotoré
- Colorectal Surgery Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | | | - Blas Flor-Lorente
- Colorectal Surgery Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | | | - Inés Aldrey Cao
- Complejo Hospitalario Universitario de Ourense, Orense, Spain
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