Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project
Por:
Pellino, G, Alos, R, Biondo, S, Codina-Cazador, A, Enriquez-Navascues, JM, Espin-Basany, E, Roig-Vila, JV, Cervantes, A, Garcia-Granero, E, Bollo J., Pascual, Vicent Viciano
Publicada:
1 feb 2021
Ahead of Print:
1 ene 2021
Resumen:
Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons.
Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I) 2006-2009; II) 2010-2013; III) 2014-2017. Survival analyses were run for 3-year survival in timeframes I-II.
Results: Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/ radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy +/- chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5% vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3% and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers.
Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN thorn benefited the most. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Filiaciones:
Pellino, G:
Univ Valencia, Hosp Univ & Politecn La Fe, Colorectal Unit, Valencia, Spain
Autonomous Univ Barcelona, Hosp Valle Hebron, Dept Gen Surg, Colorectal Surg Unit, Barcelona, Spain
Alos, R:
Univ Valencia, Hosp Univ & Politecn La Fe, Colorectal Unit, Valencia, Spain
Biondo, S:
Univ Barcelona, Bellvitge Univ Hosp, Colorectal Unit, Dept Gen & Digest Surg, Barcelona, Spain
IDIBELL, Barcelona, Spain
Codina-Cazador, A:
Josep Trueta Univ Hosp, Colorectal Unit, Dept Gen & Digest Surg, Girona, Spain
Enriquez-Navascues, JM:
Donostia Univ Hosp, Gen & Digest Surg Dept, Donostia San Sebastian, Spain
Espin-Basany, E:
Autonomous Univ Barcelona, Hosp Valle Hebron, Dept Gen Surg, Colorectal Surg Unit, Barcelona, Spain
Roig-Vila, JV:
Hosp Vithas Nisa 9 Octubre, Unit Coloproctol, Valencia, Spain
Cervantes, A:
Univ Valencia, Biomed Res Inst INCLIVA, CIBERONC, Valencia, Spain
Garcia-Granero, E:
Univ Valencia, Hosp Univ & Politecn La Fe, Colorectal Unit, Valencia, Spain
Bollo J.:
Hospital Universitari de la Santa Creu i Sant Pau de Barcelona, Spain
Pascual, Vicent Viciano:
Hospital Lluis Alcanyis de Xàtiva, Spain
Green Accepted
|