Oncology · 1 h ago
Watch-and-wait management increased among patients with stage II–III rectal cancer
A retrospective US National Cancer Database cohort study of 101,001 patients with stage II–III rectal cancer found that watch-and-wait management increased substantially over time after neoadjuvant chemoradiation. The estimated rate reached 32.94% in 2023, with earlier uptake among older patients.
- Watch-and-wait use was estimated at 32.94% in 2023.
- Rates accelerated after 2019 across the study period.
- Uptake occurred earlier among older patients.
- Database estimates do not establish individual treatment intent or outcomes.
Researchers analyzed National Cancer Database records for 101,001 patients with stage II–III rectal cancer diagnosed from 2006 to 2023 at participating Commission on Cancer–accredited US hospitals. All had received neoadjuvant chemoradiation. The retrospective cohort study estimated watch-and-wait use by measuring nonsurgical management in excess of baseline rates, which were intended to account for nonsurgical care unrelated to organ preservation.
Baseline nonsurgical management was stable through 2014, then increased: annual percentage change was 9.83% from 2015 to 2018 and 21.71% from 2019 to 2023. The estimated watch-and-wait rate rose from 2.30% in 2015 to 32.94% in 2023. Uptake occurred earlier among patients aged 80 years or older than among those younger than 50 years. Older age and later diagnosis year were independently associated with nonsurgical management.
The findings describe changing practice, not comparative cancer outcomes or the safety of watch and wait. The authors highlight the need for careful patient selection, accurate assessment of clinical response, and rigorous surveillance. As a retrospective database analysis, the study estimates intentional organ preservation indirectly and cannot establish why individual patients did not undergo surgery.
In practice
For patients with stage II–III rectal cancer after neoadjuvant chemoradiation, watch-and-wait appears to be increasingly used in US practice, reaching an estimated 32.94% in 2023. This study does not compare oncologic outcomes or establish the safety of this approach; watch-and-wait use was inferred from excess nonsurgical management in a retrospective database rather than confirmed patient-level intent. The findings support the importance of patient selection, response assessment, and surveillance but do not establish a basis for changing treatment decisions.
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JAMA Network Open: Organ Preservation With Watch and Wait in Patients With Rectal Cancer ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.