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Outcome of Patients with Locally Advanced Rectal Cancer Pursuing Non-Surgical Strategy in National Cancer Database
Hanna Kakish1, Fasih A Ahmed2, Lee M Ocuin1
1Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
Cancers
|June 27, 2024
Summary
Non-operative management (NOM) for locally advanced rectal cancer (LARC) shows inferior survival compared to surgery in real-world data. This study highlights survival differences for LARC patients managed with NOM versus surgical intervention.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Limited real-world survival data exists for locally advanced rectal cancer (LARC) patients undergoing non-operative management (NOM).
- Understanding outcomes for NOM is crucial for treatment decision-making in LARC.
Purpose of the Study:
- To compare overall survival (OS) between NOM and surgery in LARC patients.
- To analyze survival outcomes in real-world settings for different LARC subgroups.
Main Methods:
- Analysis of LARC patients (2010-2020) from the National Cancer Database.
- Stratification into cT1-3N+ and cT4N+/- groups, comparing NOM vs. surgery using Kaplan-Meier and propensity score matching.
- Multivariable analysis to assess the association between NOM and OS.
Main Results:
- NOM was associated with significantly lower OS than surgery in both cT1-3N+ and cT4N+/- groups.
- 5-year OS for cT1-3N+ was 73.9% with NOM vs. 84.5% with surgery (p < 0.001).
- 5-year OS for cT4N+/- was 44.5% with NOM vs. 72.5% with surgery (p < 0.001).
Conclusions:
- Real-world data suggests inferior survival for LARC patients treated with NOM compared to surgery.
- Surgical intervention appears to offer better survival outcomes for LARC patients in this cohort.
