Longer Interval to Surgery Associated with Poor DFS in Population With Poor Pathologic Response to Neoadjuvant CRT in Advanced Rectal Cancer

Patients who had a poor pathological response to preoperative chemoradiation for advanced rectal cancer and waited 8 weeks or longer for surgery were likely to experience poor overall disease-free survival after completing neoadjuvant chemoradiotherapy.

Among those who experienced a poor pathologic response to neoadjuvant chemoradiation, a longer interval before surgery was associated with a worse disease-free survival (DFS) among patients with advanced rectal cancer, according to an article published in JAMA Surgery.

Patients who had a longer wait time of 8 weeks or more (45.6%) vs less than 8 weeks (54.4%) had a worse 5- year overall survival rate of 67.6% (95% CI, 63.1%-71.7%) compared with 80.3% (95% CI, 76.5%-83.6%). Additionally, the 2 groups had a 10-year overall survival rate of 40.1% (95% CI, 33.5%-46.5%) and 57.8% (95% CI, 52.1%-63.0%; P <.001), respectively. Patients whose surgery was delayed had a 5-year DFS of 59.6% (95% CI, 54.9%-63.9%) compared with 72.0% (95% CI, 67.9%-75.7%). Moreover, the 10-year DFS rates were 36.2% (95% CI, 29.9%-42.4%) and 53.9% (95% CI, 48.5%-59.1%; P <.001).

A total of 1064 patients were included in the analysis. The majority of the population were men (61.5%) and the median age was 64 years. The median waiting time for surgery was 7 weeks for the shorter interval group and 10.6 weeks for the longer interval group.

Waiting longer than 8 weeks for surgery was associated with significantly higher rates of abdominal perineal resections in (33.2%) compared with those who waited less than 8 weeks (21.9%; OR, 1.71; 95% CI, 1.3-2.2; P <.001). A longer interval before surgery was also associated with higher rates of positive circumferential resection margin (1.7% vs 0.5%; OR, 3.6; 95% CI, 1.1-12.4; P = .04), 30-day morbidity rates (19.6% vs 14.8%; OR, 1.4; 95% CI, 1.0-1.9; P = .04), and surgical complication rates (15.1% vs 10.0%; OR, 1.6; 95% CI, 1.1-2.3; P = .01).

The median follow-up was 63 months, during which 26.9% of patients had disease recurrence and 37.7% had died. A total of 7.5% of patients had local recurrence, 23.9% had distant recurrence, and 4.5% had both local and distant recurrence.

A longer interval prior to surgery was also associated with a significantly higher cumulative incidence of local recurrence at 5 years (10.4% [95% CI, 7.8%-13.7%] vs 5.3% [95% CI, 3.7%-7.7%]) and 10 years (13.4% [95% CI, 9.8%-18.2%] vs 7.1% [95% CI, 5.0%-10.2%]; P = .005). A similar association was identified with regard to distant recurrence at 5-years (25.5% [95% CI, 21.6%-29.9%] vs 20.8% [95% CI, 17.5%-24.6%]), and 10 years (32.9% [95% CI, 27.9%-38.5%] vs 28.4% [95% CI, 24.1%-33.3%]; P = .055).

The use of the Cox analysis confirmed that patients who waited longer for surgery had an independent association with a higher risk of death (HR, 1.84; 95% CI, 1.50-2.26; P <.001), and death or recurrence (HR, 1.69; 95% CI, 1.39-2.04; P<.001).

Reference

Deidda S, Elmore U, Rosati R, et al. Association of delayed surgery with oncologic long-term outcomes in patients with locally advanced rectal cancer not responding to preoperative chemoradiation. JAMA Surg. Published Online September 29, 2021. doi:10.1001/jamasurg.2021.4566