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Trends in Stage, Treatment, and Outcomes in Rectal Adenocarcinoma in the United States: 2004 to 2019


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In a retrospective, observational case series study reported in JAMA Oncology, Emile et al identified changes in the stage at diagnosis, treatments, and outcomes in U.S. patients with rectal adenocarcinoma diagnosed between 2004 and 2019.

Study Details

The study used National Cancer Database data from a total of 318,548 patients diagnosed between 2004 and 2019, with factors assessed in the four equal periods of 2004 to 2007, 2008 to 2011, 2012 to 2015, and 2016 to 2019.

Key Findings

The percentage of patients aged < 50 years diagnosed with rectal cancer increased by 1.5%, from 13.9% in 2004 to 2007 to 15.4% in 2016 to 2019 (overall P < .001).

Patients diagnosed in 2016 to 2019 were more frequently diagnosed with stage III disease vs the three preceding periods (36.2% vs 30.2%, 25.0%, and 23.4%; overall P < .001), with a similar finding for stage IV disease (21.5% vs 19.3%, 18.1%, and 18.6%; overall P < .001).

The findings of this case series study suggest a treatment trend of increased use of chemotherapy, immunotherapy, sphincter-saving surgery, and minimally invasive surgery. In addition, the time between diagnosis and definitive surgery increased by a median of 33 days. This treatment trend was associated with a significant improvement in overall survival, reduction in the conversion rate by 3.9%, and a 2-day shorter hospital stay.
— Emile et al

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The use of chemotherapy (36.8% vs 48.1% vs 49.1% vs 47.0%; overall P < .001) and immunotherapy (0.4% vs 0.2% vs 3.5% vs 6.5%; overall P < .001) significantly increased from the earliest to latest period.

Use of neoadjuvant radiotherapy increased over time, from 28.6% in 2004 to 2007 to 34.3% in 2016 to 2019, whereas use of adjuvant radiotherapy decreased over time, from 12.9% to 6.0% across periods (overall P < .001).

Median time from diagnosis to definitive surgery increased from 95 days (interquartile range [IQR] = 15–126) in 2004 to 2007 to 128 days (IQR = 47–158 days) in 2016 to 2019 (overall P < .001).

Use of open surgery decreased from 60.1% in 2008 to 2011 to 30.1% in 2016 to 2019, whereas use of robotic surgery increased from 5.2% to 28.4% between the two time periods (overall P < .001). Rates of conversion to open surgery decreased from 11.2% in 2008 to 2011 to 7.3% in 2016 to 2019 (overall P < .001). Median hospital stay decreased from 6 days (IQR = 3–9 days) to 4 days (IQR = 2–7 days) between the two periods (overall P < .001).

Median overall survival increased over time, from 83.1 months (95% CI = 81.8–84.6 months) in 2004 to 2007 to 87.8 months (95% CI =86.6–90.3 months) in 2008 to 2011, and to 92.1 months (95% CI = 90.2–93.6 months) in 2012 to 2015 (overall P < .001). Follow-up was not long enough to determine median survival for diagnosis in 2016 to 2019.

The investigators concluded, “The findings of this case series study suggest a treatment trend of increased use of chemotherapy, immunotherapy, sphincter-saving surgery, and minimally invasive surgery. In addition, the time between diagnosis and definitive surgery increased by a median of 33 days. This treatment trend was associated with a significant improvement in overall survival, reduction in the conversion rate by 3.9%, and a 2-day shorter hospital stay. These findings have major clinical relevance to the management of rectal cancer. The improvements seen in short-term outcomes and survival of patients diagnosed with rectal cancer can probably be attributed to the treatment trends observed. Continued improvement in outcomes warrant further updates in treatments.”

Steven D. Wexner, MD, of the Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, is the corresponding author for the JAMA Oncology article.  

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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