Watch and wait after a clinical complete response in rectal cancer patients younger than 50 years
Author:
Bahadoer Renu R1ORCID, Peeters Koen C M J1, Beets Geerard L23ORCID, Figueiredo Nuno L45ORCID, Bastiaannet Esther16, Vahrmeijer Alexander1ORCID, Temmink Sofieke J D7, Meershoek-Klein Kranenbarg W M Elma1, Roodvoets Annet G H1, Habr-Gama Angelita8, Perez Rodrigo O8ORCID, van de Velde Cornelis J H1, Hilling Denise E19, Abdelrazeq A, Ahlberg M, Ahmed S, Asoğlu O, Barroca R G, Beveridge A J, Bhowmick A, Blower A, Braun M, Breukink S O, Bujko K, Burger J W A, Caiado A F, Campana J P, Carter P, Coco C, Coraglio M F, Creavin B, Cunningham C, Custers P A, DeBrun L, D’Hoore A, Dimofte G, Ding P, Dudaev Z, Duff S, Epstein J, Evans D, Fan M, Fechner K, Fernandez L, Fosgerau C, Fulford P, Gaertner W B, Gerard J P, Geubels B M, Goffredo P, Gollins S, Gregory E, Gryf-Lowczowski J, Haak H E, Harris R, Harrison J, Haustermans K, Heath J, Hill J, Hobbiss J, Holman F A, Huertas E, Huq Z, Iseas S, Jacquinot F, Jahansouz C, Jakobsen A, Jones L, Jones D, Nouritaromlou M K, Keshvari A, Khan U, Kushwaha R, Langheinrich M, Gonzalez M, Lees N, Linn T Y, Loganathan S, López Campos F, Madoff R D, Malcomson L, Mamedli Z Z, Marijnen C AM, Maroli A, Martens M, Martling A, von der Marwitz E A, Mastroianni G, Matzel K, Meldolesi E, Melenhorst J, Melton-Meaux G B, Minicozzi A, Mitchell P, Monterrey M, Mentz R, Murad-Regadas S, O’Dwyer S T, Pairola A, Paraoan M, Pedraza Salazar I, Pennings A J, Pettit S H, Pranesh N, Rai S, Rajaganeshan R, Ravi S, Rawat S, Renehan A G, Richards D, Riyad K, Rosa I A L, Rossi G L, Rutten H J T, Saeed M, Salaman J, Sanchez Loria F, São Julião G P, Saunders M, Schiappa R, Scott N, Selvasekar C, Siddiqui K H, Silva P, Simone I, Smart C, Solkar M H, Spinelli A, Stassen L P S, Van de Steen K, Sun Myint A, Tang J, Taylor B, Telford K, Terrasson I, Tokmak H, Vaccaro C A, Vimalchandran D, Ward S, Wilson M S, Winter D, Witjes C, Wolthuis A, Zhang Z, Zhang J,
Affiliation:
1. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands 2. Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands 3. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands 4. Digestive Unit, Champalimaud Foundation, Lisbon, Portugal 5. Colorectal Surgery, Hospital Lusíadas, Lisbon, Portugal 6. Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands 7. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden 8. Instituto Angelita e Joaquim Gama, São Paulo, Brazil 9. Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
Abstract
Abstract
Background
Young-onset rectal cancer, in patients less than 50 years, is expected to increase in the coming years. A watch-and-wait strategy is nowadays increasingly practised in patients with a clinical complete response (cCR) after neoadjuvant treatment. Nevertheless, there may be reluctance to offer organ preservation treatment to young patients owing to a potentially higher oncological risk. This study compared patients aged less than 50 years with those aged 50 years or more to identify possible differences in oncological outcomes of watch and wait.
Methods
The study analysed data from patients with a cCR after neoadjuvant therapy in whom surgery was omitted, registered in the retrospective–prospective, multicentre International Watch & Wait Database (IWWD).
Results
In the IWWD, 1552 patients met the inclusion criteria, of whom 199 (12.8 per cent) were aged less than 50 years. Patients younger than 50 years had a higher T category of disease at diagnosis (P = 0.011). The disease-specific survival rate at 3 years was 98 (95 per cent c.i. 93 to 99) per cent in this group, compared with 97 (95 to 98) per cent in patients aged over 50 years (hazard ratio (HR) 1.67, 95 per cent c.i. 0.76 to 3.64; P = 0.199). The cumulative probability of local regrowth at 3 years was 24 (95 per cent c.i. 18 to 31) per cent in patients less than 50 years and 26 (23 to 29) per cent among those aged 50 years or more (HR 1.09, 0.79 to 1.49; P = 0.603). Both groups had a cumulative probability of distant metastases of 10 per cent at 3 years (HR 1.00, 0.62 to 1.62; P = 0.998).
Conclusion
There is no additional oncological risk in young patients compared with their older counterparts when following a watch-and-wait strategy after a cCR. In light of a shared decision-making process, watch and wait should be also be discussed with young patients who have a cCR after neoadjuvant treatment.
Funder
IWWD was partly funded by the European Registration of Cancer Care, financed by the European Society of Surgical Oncology Champalimaud Foundation Lisbon Netherlands Cancer Institute Alpe d’Huzes Foundation and Dutch Cancer Society
Publisher
Oxford University Press (OUP)
Cited by
13 articles.
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