EP100 - Accelerating Adoption of Organ Preservation in Rectal Cancer: Evidence of a Paradigm Shift Across All Ages

ePoster Presenter(s)

• 

  Stephanie Keeling, MD

  General Surgery Resident
  Baylor College of Medicine
  The University of Texas MD Anderson Cancer Center
  Houston, TX, United States

  Disclosure information not submitted.

Author(s)

• CH

  Chung-Yuan Hu, MPH PhD

  Senior Research Scientist, Department of Colon and Rectal Surgery
  University of Texas at MD Anderson Cancer Center
  Houston, Texas, United States

  Disclosure information not submitted.
• 

  Ramy Behman, MD PhD

  Assistant professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  MD Anderson Cancer Center
  Houston, TX, United States

  Disclosure information not submitted.
• JL

  John Lin, MD, MSHP

  Assistant Professor, Department of Health Services Research and Genitourinary Medical Oncology
  University of Texas at MD Anderson Cancer Center
  Houston, Texas, United States

  Disclosure information not submitted.
• 

  Jeongyoon Moon, M.D., MSc, FACS

  Assistant Professor, Department of Colon and Rectal Surgery
  University of Texas at MD Anderson Cancer Center
  Houston, Texas, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Paula M. Smith, MD, PhD

  Assistant Professor of Surgery
  University of Texas MD Anderson Cancer Center
  MD Anderson Cancer Center
  Houston, TX, United States

  Disclosure information not submitted.
• 

  Michael G. White, M.D., MSc.

  Assistant professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  Houston, Texas, United States

  Disclosure information not submitted.
• 

  Montserrat Guraieb-Trueba, MD

  Assistant Professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  Houston, TX, United States

  Disclosure information not submitted.
• 

  Yi-Qian Nancy You, M.D., MHSc, FACS

  Professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  University of Texas MD Anderson Cancer Center
  Houston, Texas, United States

  Disclosure information not submitted.
• 

  Craig A. Messick, M.D., FACS, FASCRS

  Associate professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  Houston, Texas, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  J. Joshua Smith, MD, PhD

  Professor and Chair, Colon and Rectal Surgery Department
  MD Anderson Cancer Center
  MD Anderson Cancer Center
  Houston, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Tsuyoshi Konishi, M.D., PhD.

  Associate professor
  Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
  The University of Texas MD Anderson Cancer Center
  Houston, Texas, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  George J. Chang, MD, MS, MHCM (he/him/his)

  Associate Vice President and Professor
  University of Texas MD Anderson Cancer Center
  The University of Texas MD Anderson Cancer Center
  Houston, TX, United States

  Disclosure information not submitted.

Purpose/Background: With growing evidence and evolving guidelines, organ preservation (OP) with Watch & Wait (W&W) for stage II/III rectal cancer after neoadjuvant therapy is being increasingly implemented. However, the frequency with which OP is being utilized is unknown. The objective of this study was to determine rates of intentional OP with W&W by evaluating secular trends in adoption of OP across age groups. We hypothesized that rates of OP increased across all age groups, with the highest rates among the oldest cohorts.

Methods/Interventions: Patients with stage II-III rectal cancer diagnosed between 2006 and 2022 who received neoadjuvant chemoradiation were identified from the National Cancer Database. To account for non-surgical management unrelated to guideline-driven decisions (e.g., due to patient factors), joinpoint regression was used to estimate baseline rates of non-surgical management and calculate annual percentage changes (APCs), representing log-linear trends. Intentional OP rates were defined as excess non-surgical management above baseline rates. Association between age, year of diagnosis, and the likelihood of OP were assessed using multivariable logistic regression.

Results/Outcomes: Among 99,046 patients (18,876 managed non-surgically; 80,170 surgically), baseline rates of non-surgical management remained stable through 2014. Joinpoint regression identified 2014 and 2019 as inflection points for adoption of OP; corresponding APCs were -0.37% [95% confidence interval (CI): -2.60 to 0.98] in 2006-2014, 9.60% [CI: 3.68 to 13.86] in 2015-2018, and 23.4% [CI: 17.21 to 40.44] in 2019-2022. Between 2006-2014, baseline non-surgical management rates were highest among older patients, ranging from 9.3% (age < 40 years) to 41.8% (age ≥80 years).

Analysis of excess rates of non-surgical management above baseline (Figure 1) revealed age-specific patterns of adoption of OP. Earlier adoption was observed among older patients: ≥80 age group surpassed 5% excess OP by 2015 and 10% by 2019, while < 40 group reached those same thresholds in 2019 and 2021, respectively. All age groups demonstrated significant increases in rates of OP after 2014, with both year (p < 0.001) and older age (p < 0.001) independently associated with higher rates of OP.

Conclusion/Discussion: OP rates have increased across all age groups, with approximately 1 in 3-5 patients managed with OP in 2022. The marked acceleration observed after 2019 suggests evidence-driven increases in adoption of OP for rectal cancer across all age groups.

Figure 1. Rates of Organ Preservation Above Baseline Non-Surgical Management
Rates of OP relative to the 2006-2014 baseline non-surgical management, stratified by age group and year of diagnosis (2015-2022).