Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK; Department of Surgery and Cancer, Imperial College London, London, UK; North Cumbria Integrated Care NHS Foundation Trust, UK.
Clin Oncol (R Coll Radiol). 2022 Jan;34(1):e25-e34. doi: 10.1016/j.clon.2021.08.004. Epub 2021 Aug 26.
Although there is emerging evidence to suggest equivalent oncological outcomes using a watch and wait approach compared with primary total mesorectal excision surgery, there is a paucity of evidence about the safety and efficacy of this approach in routine clinical practice. Here we report the long-term outcomes and quality of life from patients managed with watch and wait following a clinical complete response (cCR) to neoadjuvant therapy.
Patients with adenocarcinoma of the rectum with cCR following neoadjuvant therapy managed using watch and wait were retrospectively identified. Demographic data, performance status, pretreatment staging information, oncological and surgical outcomes were obtained from routinely collected clinical data. Quality of life was measured by trained clinicians during telephone interviews.
Over a 7-year period, 506 patients were treated for rectal cancer, 276 had neoadjuvant therapy and 72 had a cCR (26.1%). Sixty-three were managed with watch and wait. Thirteen patients had mucosal regrowth. There was no significant difference in the incidence of metastatic disease between the surgical and watch and wait cohorts (P = 0.38). The 13 patients with mucosal regrowth underwent salvage surgery. Eleven of the patients who underwent surgical resection had R0 resections. There was also a statistically and clinically significant improvement in the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) trial outcome index (P = 0.022).
This study shows that watch and wait is safe and effective outside of tertiary referral centres. It suggests that an opportunistic cCR is durable and when mucosal regrowth occurs it can be salvaged. Finally, we have shown that quality of life is probably improved if a watch and wait approach is adopted.
尽管有越来越多的证据表明，与原发性全直肠系膜切除术相比，采用观察等待策略可以获得等效的肿瘤学结果，但关于这种方法在常规临床实践中的安全性和疗效的证据仍然很少。在这里，我们报告了在新辅助治疗后获得临床完全缓解（cCR）的患者采用观察等待策略的长期结果和生活质量。
回顾性地确定了新辅助治疗后出现 cCR 并采用观察等待策略进行治疗的直肠腺癌患者。从常规收集的临床数据中获取人口统计学数据、表现状态、治疗前分期信息、肿瘤学和手术结果。通过训练有素的临床医生在电话访谈中测量生活质量。
在 7 年的时间里，506 例直肠癌患者接受了治疗，其中 276 例接受了新辅助治疗，72 例获得了 cCR（26.1%）。63 例患者接受了观察等待策略。13 例患者出现黏膜再生。手术组和观察等待组的转移性疾病发生率无显著差异（P = 0.38）。13 例黏膜再生患者接受了挽救性手术。接受手术切除的 11 例患者获得了 RO 切除。功能性评估癌症治疗-结直肠癌（FACT-C）试验结局指数也有统计学和临床意义的改善（P = 0.022）。
这项研究表明，观察等待策略在三级转诊中心之外也是安全有效的。它表明偶然的 cCR 是持久的，并且当出现黏膜再生时，可以进行挽救。最后，我们表明，如果采用观察等待策略，生活质量可能会得到改善。
