Which factors predict OS, nonoperative management in rectal adenocarcinoma?

Receiving nonoperative management (NOM) and overall survival (OS) among patients with rectal adenocarcinoma are associated with several demographic factors and social determinants of health, according to a study.

Age >70 years, Charlson-Deyo score of 0, race (Black, Asian or Pacific Islander, or other vs White), insurance status, geographical region, treatment in a community facility, year of diagnosis (2012-2018 vs 2004-2011), tumour grade 1 vs ≥2, clinical T-stage ≥2, and clinical N1 or N2 vs N0 significantly correlated with receipt of NOM.

Poorer OS among patients who received NOM was associated with the following factors: age >70 years, male sex, Charlson-Deyo score ≥ 1, insurance status, geographical region, rural urban density vs metro/urban, treatment in a community facility, year of diagnosis (2004-2011 vs 2012-2018), clinical T4 versus T1, clinical N1 or N2 vs N0, grade 3 vs 1, treatment with a radiotherapy dose <45 Gy vs 45 to 54 Gy, and omission of chemotherapy.

“With the increasing utilization of NOM, it will be important to understand the drivers of treatment decisions and influences on access to the desired treatment approach,” the authors said.

This retrospective cohort study was conducted using the National Cancer Database. A total of 128,297 patients with stage 1 to 3 rectal adenocarcinoma were included in the analysis. Of these, 115,888 (90.3 percent) received surgery, and 12,409 (9.7 percent) received NOM.