Investigation of the Clinicopathological Characteristics and Survival Outcomes of Patients Refusing Surgery Post-Neoadjuvant Therapy in Rectal Cancer
Senar Ebinc1, Zeynep Oruc1, Ziya Kalkan1, Zuhat Urakci1, Savas Topuk2, Ulas Aday3, Bekir Tasdemir4, Muhammet Ali Kaplan1, Mehmet Kucukoner1, Abdurrahman Isikdogan11Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye, 2Department of Radiation Oncology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye, 3Department of Gastrointestinal Surgery, Dicle University Faculty of Medicine, Diyarbakır, Türkiye, 4Department of Nuclear Medicine, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
Objectives: In locally advanced rectal cancer, the standard treatment approach consists of post-neoadjuvant surgery and adjuvant chemotherapy. In this study, we aimed to evaluate the clinicopathological characteristics of patients receiving neoadjuvant therapy for a diagnosis of rectal cancer and to compare the survival outcomes of patients who underwent surgery and patients who refused the surgical approach after neoadjuvant therapy, regardless of response status. Methods: Our study included patients who presented to our clinic and underwent neoadjuvant therapy for locally advanced or oligometastatic rectal carcinoma between 2011 and 2021. Patients who did not complete neoadjuvant therapy or progressed on treatment were excluded. Patient data were retrospectively reviewed using the hospital records system. Results: Our study analyzed data from a total of 123 patients, consisting of 98 (79.7%) patients in the surgery arm and 25 (20.3%) patients in the refusal arm. In our study, 65 (52.8%) patients were female and 58 (47.2%) patients were male. Median age at diagnosis was 53 years (20-86). Most of the patients (75.6%) had stage-III disease. Regarding response to neoadjuvant therapy; complete response was obtained in 16.3% (n=20), partial response was obtained in 71.5% (n=88), stable disease was obtained in 12.2% (n=15) of the patients. After neoadjuvant therapy, 20.3% of the patients had refused surgery and started follow-up. Of the 98 (79.7%) operated patients, 77 (26.6%) had been treated with a low anterior resection and 21 (17.1%) with an abdominoperineal resection. During follow-up, 29.3% (n=36) of the patients showed recurrence or progression. While progression-free survival could not be reached for operated patients, patients refusing surgery had a median recurrence free survival of 32 months (6.3-57.6) (Log-rank p=0.003). Median overall survival was 144 months (46.3-241.6) in operated patients as opposed to 41 (23.0-58.9) months in those refusing surgery (Log-rank p<0.001). Operated patients and patients refusing surgery had three-year survival rates of 64.9% vs 40% (p=0.023) and five-year survival rates of 45.4% vs 16% (p=0.007), respectively. Conclusion: We determined that, in rectal cancer, both the overall survival and progression/recurrence-free survival outcomes of patients refusing surgery were poorer than those in the surgery arm, regardless of response status. Keywords: Neoadjuvant therapy, prognosis, rectal cancer, refusal of surgery
Cite This Article
Ebinc S, Oruc Z, Kalkan Z, Urakci Z, Topuk S, Aday U, Tasdemir B, Kaplan M, Kucukoner M, Isikdogan A. Investigation of the Clinicopathological Characteristics and Survival Outcomes of Patients Refusing Surgery Post-Neoadjuvant Therapy in Rectal Cancer. EJMI. 2022; 6(4): 401-408
Corresponding Author: Senar Ebinc