Global variation in the long-term outcomes of ypT0 rectal cancers

• Published in: European journal of surgical oncology 2020-03, Vol.46 (3), p.420-428
• Main Authors: Lorenzon, Laura, Evrard, Serge, Gonzalez-Moreno, Santiago, Kovacs, Tibor, D’Ugo, Domenico, Polom, Karol, Shinde, Rajesh S., Saklani, Avanish, Martins, Pedro, Videira, José Flávio, Achimas-Cadariu, Patriciu, Marinello, Franco, Espin, Eloy, Xenaki, Sofia, Lasithiotakis, Konstantinos, Rega, Daniela, Delrio, Paolo, Andrási, László, Lázár, György, Quattromani, Roberto, Elmore, Ugo, Branciforte, Martina Azzurra, Piazza, Diego, Sztipits, Tamás, Mersich, Tamás, Vigorita, Vincenzo, Ildefonso, Alberto San, Cianflocca, Desiree, Giuffrida, Maria Carmela, Biondi, Alberto, Grosek, Jan, Coco, Claudio, Dieninyte-Misiune, Egle, Bausys, Rimantas, Bausys, Augustinas, Poskus, Tomas, Dupré, Aurélien, Muresan, Mihai-Stefan, Ionescu, Călin, Alyami, Mohammad, Cotte, Eddy, Candido, Francesca Di, Spinelli, Antonino, Lucarini, Alessio, Balducci, Genoveffa, Kisielewski, Michał, Pędziwiatr, Michał, Kroon, Hidde, Sammour, Tarik, Unger, Lukas, Stift, Anton, Marsanic, Patrizia, Muratore, Andrea, Uzunoglu, Mustafa Yener, Altintoprak, Fatih, Capponi, Michela Giulii, Poiasina, Elia, Brandl, Andreas, Aigner, Felix, Aparício, David, Leichsenring, Carlos, Corleone, Pio, Manzini, Nicolò de, Kabata, Paweł, Świerblewski, Maciej, Negoi, Ionut, Beuran, Mircea, Souriti, Ahmad, Taylor, Gregory, De Luca, Raffaele, Simone, Michele, Bedford, Matthew, Charalampakis, Vasileios, Rajan, Shiv, Chaturvedi, Arun, Parini, Dario, Turati, Luca, Sgroi, Giovanni, Bratu, Matei, Diaconescu, Bogdan, Slavchev, Mihail, Belev, Nikolay, Perfumo, Mariana Matzner, Wajda, Justyna, Wysocki, Wojciech, Fernandez, Carmen Cagigas, Ruiz, Marcos Gomez, Marino, Serafino, Resta, Giuseppe, Ivanov, Tsvetomir, Dimitrov, Dobromir, Kaufmann, Claudia, Kafka-Ritsch, Reinhold, Yalkin, Omer, Loche, Giovanni Augusto, Cillara, Nicola, Colombo, Francesco, Foschi, Diego, Pollesel, Sara, Roviello, Franco
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2019.10.010

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