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Global variation in the long-term outcomes of ypT0 rectal cancers
European journal of surgical oncology, 2020-03, Vol.46 (3), p.420-428
2020
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Autor(en) / Beteiligte
Titel
Global variation in the long-term outcomes of ypT0 rectal cancers
Ist Teil von
  • European journal of surgical oncology, 2020-03, Vol.46 (3), p.420-428
Ort / Verlag
England: Elsevier Ltd
Erscheinungsjahr
2020
Quelle
Elsevier ScienceDirect Journals
Beschreibungen/Notizen
  • Colorectal cancer mortality presents world-wide variation. In rectal cancers presenting a complete/nearly-complete tumor response (ypT0/ypTis) following neoadjuvant treatment, the features correlated to nodal metastases and relapses still need to be defined. An international cohort study enrolling ypT0/ypTis rectal cancers surgically treated from 2012 to 2017 was conducted. A propensity matching was used to balance nodal-positive and nodal-negative patients and statistical analyses were performed to investigate survivals, using a bootstrap model for internal validation. The features correlated with nodal metastasis were studied. Countries with participating centers were ranked using the World Bank (WBI), Human Development (HDI) and Global Gender Gap (GGG) indexes to compare survivals. 680 ypT0/ypTis from 52 European, Australian, Indian and American Institutions were analyzed. Mean follow-up was of 30.4 months. 96.5% were treated with total mesorectal excision, 7.2% were nodal-positive and 8.8% relapsed. Distal cancers (HR 0.71 95%CI: 0.56-0.91) and nodal metastasis and nodal metastasis (HR 3.85 95%CI:1.12–13.19) correlated with worse DFS, whereas a younger age was of borderline significance (HR 0.95 95%CI:0.91–0.99). The bootstrap analysis validated the model on 5000 repetitions. A short-course radiotherapy (OR 0.18 95%CI:0.09–0.37) correlated with the occurrence of nodal metastasis. Those countries classified in the low/medium-WBI, medium-HDI and lower-GGG ranks documented worse DFS curves (respectively p < 0.0001, p < 0.0001 and p 0.0002). However, the clinical stages were similar and patients from medium-HDI countries received more adjuvant chemotherapy than the others (p < 0.0001). Sub-groups at risk for relapses and nodal metastasis were identified. A global variation exists also when benchmarking a rectal cancer complete regression.
Sprache
Englisch
Identifikatoren
ISSN: 0748-7983
eISSN: 1532-2157
DOI: 10.1016/j.ejso.2019.10.010
Titel-ID: cdi_proquest_miscellaneous_2315529509
Format
–
Schlagworte
Adult, Chemoradiotherapy, Adjuvant, Colectomy - methods, Complete tumor response, Female, Follow-Up Studies, Humans, Local excision, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging - methods, Organ preservation, Rectal cancer, Rectal Neoplasms - diagnosis, Rectal Neoplasms - secondary, Rectal Neoplasms - therapy, Retrospective Studies, Time Factors, Treatment Outcome, ypT0

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