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Baseline MRI predictors of successful organ preservation in the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial.
Williams, Hannah; Yuval, Jonathan B; Verheij, Floris S; Miranda, Joao; Lin, Sabrina T; Omer, Dana M; Qin, Li-Xuan; Gollub, Marc J; Kim, Tae-Hyung; Garcia-Aguilar, Julio.
Afiliação
  • Williams H; Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Yuval JB; Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Verheij FS; Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
  • Miranda J; Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Lin ST; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Omer DM; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Qin LX; Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Gollub MJ; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Kim TH; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
  • Garcia-Aguilar J; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Br J Surg ; 111(9)2024 Aug 30.
Article em En | MEDLINE | ID: mdl-39319400
ABSTRACT

BACKGROUND:

Prospective randomized trials have not yet identified baseline features predictive of organ preservation in locally advanced rectal cancers treated with total neoadjuvant therapy and a selective watch-and-wait strategy.

METHODS:

This was a secondary analysis of the OPRA trial, which randomized patients with stage II-III rectal adenocarcinoma to receive either induction or consolidation total neoadjuvant therapy. Patients were recommended for total mesorectal excision, or watch and wait based on clinical response at 8 ± 4 weeks after completing treatment. Standardized baseline clinical and radiological variables were collected prospectively. Survival outcomes, including total mesorectal excision-free survival, disease-free survival, and overall survival, were assessed by intention-to-treat analysis. Cox proportional hazards models were used to evaluate associations between baseline variables and survival outcomes.

RESULTS:

Of the 324 patients randomized for the OPRA trial, 38 (11.7%) had cT4 tumours, 230 (71.0%) cN-positive disease, 101 (32.5%) mesorectal fascia involvement, and 64 (19.8%) extramural venous invasion. Several baseline features were independently associated with recommendation for total mesorectal excision on multivariable

analysis:

nodal disease (HR 1.66, 95% c.i. 1.12 to 2.48), extramural venous invasion (HR 1.57, 1.07 to 2.29), mesorectal fascia involvement (HR 1.45, 1.01 to 2.09), and tumour length (HR 1.11, 1.00 to 1.22). Of these, nodal disease (HR 2.02, 1.15 to 3.53) and mesorectal fascia involvement (HR 2.02, 1.26 to 3.26) also predicted worse disease-free survival. Age (HR 1.03, 1.00 to 1.06) was associated with overall survival.

CONCLUSION:

Baseline MRI features, including nodal disease, extramural venous invasion, mesorectal fascia involvement, and tumour length, independently predict the likelihood of organ preservation after completion of total neoadjuvant therapy. Mesorectal fascia involvement and nodal disease are associated with disease-free survival.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Retais / Imageamento por Ressonância Magnética / Adenocarcinoma / Terapia Neoadjuvante / Tratamentos com Preservação do Órgão Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Surg Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Retais / Imageamento por Ressonância Magnética / Adenocarcinoma / Terapia Neoadjuvante / Tratamentos com Preservação do Órgão Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Surg Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Reino Unido