Conditional Survival in Patients with Locally Advanced Rectal Cancer and Pathologic Complete Response: Results from...

Area of Science:

• Oncology
• Clinical Medicine
• Surgical Oncology

Background:

• Locally advanced rectal cancer (LARC) patients achieving pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) have a favorable prognosis.
• Current follow-up protocols for these patients are often similar to those with worse prognoses, leading to unnecessary psychological and economic burdens.

Purpose of the Study:

• To analyze oncological outcomes and recurrence-free survival (RFS) in LARC patients who achieved pCR after NCRT and surgery.
• To evaluate the potential for adapting follow-up strategies based on conditional survival analysis.

Main Methods:

• Retrospective, observational, multicenter study using data from the Spanish Rectal Cancer Project.
• Included 815 LARC patients who underwent curative surgery post-NCRT and achieved pCR.
• Conditional survival models were used to analyze RFS at 1, 2, and 3 years post-surgery.

Main Results:

• The overall 5-year RFS was 86.5%.
• For patients surviving 1, 2, and 3 years post-surgery, RFS probabilities were 89.4%, 92.9%, and 95.2%, respectively.
• The probability of recurrence significantly decreased over time, with only 0.6% recurrence risk after 3 years.

Conclusions:

• Follow-up intensity for LARC patients with pCR post-NCRT and surgery can be adapted.
• Conditional survival data demonstrate that RFS probability increases with time, supporting less intensive monitoring for long-term survivors.
• Late recurrences (>3 years) are exceptional, suggesting a potential for de-escalation of surveillance.