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直肠癌新辅助治疗后观察等待：国际观察等待数据库（IWWD）中首次重新评估时完全缓解与无完全缓解患者结局的比较。

Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD).

机构信息

Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.

出版信息

Br J Surg. 2023 May 16;110(6):676-684. doi: 10.1093/bjs/znad051.

DOI:10.1093/bjs/znad051
PMID:36972213
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10364523/
Abstract

BACKGROUND: In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment. METHODS: This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality. RESULTS: A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI. CONCLUSION: Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.

摘要

背景：在新辅助治疗后达到 cCR 的直肠癌患者，观察与等待策略已具有充分的证据支持。然而，对于接近 cCR 的定义和处理，目前尚未达成共识。本研究旨在比较首次和再次评估时达到 cCR 的患者的结局。

方法：本研究为国际观察与等待数据库的注册研究，基于 MRI 和内镜，将患者分为首次评估时达到 cCR 和再次评估时达到 cCR（即首次评估时为接近 cCR）。计算保肛率、无远处转移生存率和总生存率。根据不同的评估方式，对接近 cCR 组进行亚组分析。

结果：共纳入 1010 例患者，其中 608 例患者在首次评估时达到 cCR，402 例患者在再次评估时达到 cCR。首次评估时达到 cCR 患者的中位随访时间为 2.6 年，再次评估时达到 cCR 患者的中位随访时间为 2.9 年。首次评估时达到 cCR 患者的 2 年保肛率为 77.8%（95%可信区间 74.2%至 81.5%），再次评估时达到 cCR 患者的 2 年保肛率为 79.3%（75.1%至 83.7%）（P=0.499）。同样，两组在无远处转移生存率或总生存率方面也无差异。亚组分析显示，仅通过 MRI 评估为接近 cCR 的患者保肛率更高。

结论：再次评估时达到 cCR 的患者的肿瘤学结局并不比首次评估时达到 cCR 的患者差。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/05bf83a8520d/znad051f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/2ad9c028f084/znad051f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/54b1fd28e2dc/znad051f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/2a8bbec03b00/znad051f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/05bf83a8520d/znad051f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/2ad9c028f084/znad051f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/54b1fd28e2dc/znad051f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/2a8bbec03b00/znad051f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8bf1/10364523/05bf83a8520d/znad051f4.jpg

相似文献

[1]
Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD).

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[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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引用本文的文献

[1]
How best to combine DWI and T2WI to predict pathologic complete response: a multi-center study on interpreting MRI following chemoradiotherapy of rectal cancer.

Eur Radiol. 2025-8-15

[2]
The Ongoing Development of Watch and Wait.

Clin Colon Rectal Surg. 2024-11-4

[3]
Editorial: Organ preservation for rectal cancer patients.

Front Surg. 2025-4-25

[4]
Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort.

Ther Adv Med Oncol. 2025-5-9

[5]
The Landmark Series: Organ Preservation in Rectal Cancer-The Watch and Wait Strategy.

Ann Surg Oncol. 2025-4-26

[6]
The tumour-stroma ratio as predictive aid towards a biopsy-based treatment strategy in rectal carcinoma.

Histopathology. 2025-7

[7]
Rectal cancer approach strategies after neoadjuvant treatment - a systematic review and network meta-analysis.

Int J Surg. 2025-4-1

[8]
Risk Factors for Regrowth After Nonoperative Management for Rectal Cancer.

Ann Surg Oncol. 2025-5

[9]
Short-term outcomes from the 'Watch and Wait' (WoW) study: prospective cohort study.

BJS Open. 2024-12-30

[10]
Correlation Between Grade of Clinical Response to Neoadjuvant Therapy for Rectal Cancer and Oncologic Outcomes in the Era of Watch-and-Wait.

Dis Colon Rectum. 2025-3-1

本文引用的文献

[1]
Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy.

J Clin Oncol. 2022-8-10

[2]
Initial magnetic resonance imaging tumour regression grade (mrTRG) as response evaluation after neoadjuvant treatment predicts sustained complete response in patients with rectal cancer.

Eur J Surg Oncol. 2022-7

[3]
Can we Save the rectum by watchful waiting or TransAnal surgery following (chemo)Radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC)? Protocol for the international, multicentre, rolling phase II/III partially randomized patient preference trial evaluating long-course concurrent chemoradiotherapy versus short-course radiotherapy organ preservation approaches.

Colorectal Dis. 2022-5

[4]
Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?

Colorectal Dis. 2022-4

[5]
Organ preservation following short-course radiotherapy for rectal cancer.

BJS Open. 2021-9-6

[6]
Re-staging and follow-up of rectal cancer patients with MR imaging when "Watch-and-Wait" is an option: a practical guide.

Insights Imaging. 2021-8-9

[7]
International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer.

Nat Rev Clin Oncol. 2021-12

[8]
Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study.

Lancet Gastroenterol Hepatol. 2021-2

[9]
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial.

Lancet Oncol. 2021-1

[10]
Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial.

Lancet Gastroenterol Hepatol. 2020-2-7

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