Changes in treatment have led to improvements in overall survival for patients with rectal cancer in the United States, according to research published in JAMA Oncology.

Over the period studied, the use of chemotherapy, immunotherapy, sphincter-saving surgery, and minimally invasive surgery all increased. The overall use of surgery decreased, and the time between diagnosis and definitive surgery increased. 

“This treatment trend was associated with a significant improvement in overall survival, a reduction in conversion rate by 3.9%, and a 2-day shorter hospital stay,” the researchers wrote.


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For this study, researchers evaluated data from 318,548 patients in the National Cancer Database who were diagnosed with rectal adenocarcinoma from 2004 through 2019. 

The percentage of patients with early-onset rectal cancer increased by 1.5% over the study period, from 13.9% in 2004-2007 to 15.4% in 2016-2019.

Patients were more likely to present with later-stage disease during 2016-2019 compared with earlier time periods. For example, during 2016-2019, 36.2% of patients presented with stage III disease and 21.5% presented with stage IV disease. During 2004-2007, 23.4% of patients presented with stage III disease and 18.6% presented with stage IV disease.

Treatment changed over time as well. The use of chemotherapy increased from 36.8% in 2004-2007 to 47.0% in 2016-2019 (P <.001). The use of immunotherapy increased from 0.4% to 6.5% (P <.001).

The percentage of patients who did not undergo surgery increased from 30.9% in 2004-2007 to 40.8% in 2016-2019 (P <.001). The median time from diagnosis to definitive surgery increased from 95 days to 128 days (P <.001). 

However, there was an increase in the use of robotic surgery, from 5.2% in 2008-2011 to 28.4% in 2016-2019 (P <.001). The use of laparoscopic surgery also increased from 34.7% in 2008-2011 to 41.4% in 2016-2019 (P <.001). (Data were not available for 2004-2007.)

Among patients who underwent surgery, the proportion who were readmitted to the hospital within 30 days decreased over time. Unplanned readmissions decreased from 6.0% to 5.5% (P <.001). The median duration of a hospital stay decreased from 6 days in 2004-2007 to 4 days in 2016-2019 (P <.001).

The median overall survival increased from 83.1 months in 2004-2007 to 87.8 months in 2008-2011 and 92.1 months in 2012-2015 (P < .001). The 2016-2019 time period was not included in the overall survival analysis due to insufficient follow-up.

“This notable improvement in survival, despite the increased prevalence of patients with stage IV disease, was attestable to better multidisciplinary care and improved therapeutic options,” the researchers concluded.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Emile SH, Horesh N, Freund MR, et al. Trends in the characteristics, treatment, and outcomes of rectal adenocarcinoma in the US from 2004 to 2019: A National Cancer Database analysis. JAMA Oncol. Published online December 29, 2022. doi:10.1001/jamaoncol.2022.6116