Matched analysis of long-term oncological outcomes between watch-and-wait strategy and radical surgery after neoadjuvant therapy for rectal cancer

Table 1 Baseline characteristics of patients in the watch-and-wait and radical surgery groups, n (%)/mean ± SD

Characteristic	Watch-and-wait group (n = 45)	Radical surgery group (n = 45)	Statistic	P value
Age (years)	58 (52-65)	60 (54-66)	Z = 0.891	0.373
Sex			χ2 = 0.000	1.000
Male	28 (62.22)	28 (62.22)
Female	17 (37.78)	17 (37.78)
BMI (kg/m2)	23.55 ± 2.84	23.86 ± 3.12	t = 0.485	0.629
ASA grade			χ2 = 0.211	0.900
I	18 (40.00)	16 (35.56)
II	24 (53.33)	26 (57.78)
III	3 (6.67)	3 (6.67)
Baseline cT stage			χ2 = 0.200	0.905
cT2	10 (22.22)	9 (20.00)
cT3	32 (71.11)	33 (73.33)
cT4a	3 (6.67)	3 (6.67)
Baseline cN stage			χ2 = 0.467	0.792
cN0	15 (33.33)	13 (28.89)
cN1	22 (48.89)	24 (53.33)
cN2	8 (17.78)	8 (17.78)
Tumor distance from anal verge (cm)	4.22 ± 1.57	4.05 ± 1.62	t = 0.499	0.619
Pre-treatment CEA (ng/mL)	3.8 (2.1-6.5)	4.1 (2.3-7.0)	Z = 0.612	0.541
Assessment interval (weeks)	10.23 ± 1.17	10.49 ± 1.36	t = 0.962	0.339

BMI: Body mass index; ASA: American Society of Anesthesiologists (Physical Status Classification System); CEA: Carcinoembryonic antigen.

Table 2 Comparison of recurrence patterns between the watch-and-wait and radical surgery groups, n (%)

Group	Case number	Local regrowth/recurrence	Distant metastasis	Overall recurrence rate
Watch-and-wait group	45	5 (11.11)	1 (2.22)	6 (13.33)
Radical surgery group	45	2 (4.44)	2 (4.44)	4 (8.89)
χ2 value	-	-	-	0.480
P value	-	-	-	0.736

Table 3 Comparison of quality of life scores between the watch-and-wait and radical surgery groups, mean ± SD

Scale	Domain	Watch-and-wait group (n = 42)	Radical surgery group (n = 42)	t value	P value
QLQ-C30	Global health status	82.45 ± 9.14	75.69 ± 10.34	3.229	0.002
	Physical functioning	88.23 ± 8.56	85.74 ± 9.88	1.256	0.212
	Role functioning	86.92 ± 10.28	80.13 ± 12.42	2.783	0.007
	Emotional functioning	84.54 ± 11.37	78.07 ± 13.65	2.373	0.020
	Cognitive functioning	87.11 ± 9.85	84.36 ± 11.09	1.198	0.234
	Social functioning	83.63 ± 12.17	76.45 ± 14.58	2.466	0.016
	Fatigue symptom	12.84 ± 9.59	18.95 ± 11.23	2.705	0.008
	Pain symptom	8.35 ± 7.13	13.67 ± 9.86	2.880	0.005
	Insomnia symptom	10.26 ± 8.48	16.78 ± 12.05	2.915	0.005
QLQ-CR29	Urinary problems	15.42 ± 10.84	22.12 ± 13.55	2.554	0.012
	Diarrhea	16.75 ± 12.40	25.34 ± 14.97	2.936	0.004
	Bowel function problems	18.26 ± 11.62	21.53 ± 13.88	1.200	0.233

QLQ-C30: Quality of Life Questionnaire-Core 30; QLQ-CR29: Quality of Life Questionnaire-Colorectal Cancer Module (29 items).

Table 4 Multivariate Cox regression analysis of factors associated with 3-year disease-free survival

Variable	β value	SE	Wald χ2	P value	HR (95%CI)
Age (≥ 60 vs < 60)	0.452	0.531	0.724	0.395	1.571 (0.555-4.450)
Gender (male vs female)	-0.287	0.518	0.307	0.580	0.751 (0.272-2.073)
Baseline cT stage (T3-4 vs T2)	0.891	0.712	1.566	0.211	2.438 (0.604-9.838)
Baseline cN stage (N2 vs N0-1)	1.418	0.604	5.512	0.019	4.128 (1.265-13.468)
Treatment strategy (radical surgery vs watch-and-wait)	-0.384	0.515	0.556	0.456	0.681 (0.248-1.868)
Pathological response (non-pCR vs pCR)	0.723	0.782	0.855	0.355	2.061 (0.445-9.538)

pCR: Pathological complete response; HR: Hazard ratio; CI: Confidence interval.