Total mesorectal excision is the standard surgery for locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT), but it may lead to high complication rates and poor quality of life. This study evaluates whether transanal endoscopic microsurgery (TEM), as a partial resection procedure, can enhance quality of life for clinical complete response (cCR) or near-cCR patients without compromising survival. Between May 2017 to September 2021, 80 patients with T3-4N0M0 or TanyN+M0 mid-low rectal cancer achieving cCR or near-cCR post-nCRT were prospectively included at 6 Chinese centers. Patients underwent either TEM (Group A, n=38) or radical surgery (Group B, n=41). Clinicopathological, oncological, and functional outcomes were analyzed. Postoperative histology revealed 22 ypT0 (57.9%), 5 ypT1 (13.2%), 10 ypT2 (26.3%), and 1 ypT3 (2.6%) cases in group A and 20 pCR (48.8%), 1 T0N1 (2.4%), 5 T1N0 (12.2%), 12 T2-3N0 (29.3%), 3 T2-3N1 (7.3%) cases in group B. After a 60-month median follow-up, local recurrence occurred in 2 patients (5.26%) in Group A and none in Group B. Distant metastases occurred in 8 patients (21.05%) in group A and 7 (17.07%) in group B. There was no significant difference between the two groups in 5-year disease-free survival (P=0.658) or 5-year overall survival (P=0.465). Group A showed significantly faster recovery (P<0.001) and better sphincter function per Wexner (1 vs. 4, P=0.001) and LARS (0 vs. 17, P<0.001) scores than Group B. TEM may be an effective approach for assessing residual tumors in LARC patients with cCR or near-cCR. This approach offers an option for those requiring sphincter preservation, with no significant compromise in long-term oncological outcomes observed in our study.

BackgroundThe introduction of proteasome inhibitors (PIs) and lenalidomide as treatment for newly diagnosed multiple myeloma (MM) has led to an increased population of lenalidomide-refractory patients. Limited data are available characterizing current treatments and outcomes in this difficult-to-treat population. MethodsIndividual patient-level data were analyzed from the treatment arms of multiple daratumumab studies, including APOLLO, CASTOR, CANDOR, EQUULEUS, ALCYONE, MAIA, GRIFFIN, POLLUX, and CASSIOPEIA. Included patients were PI exposed and lenalidomide refractory, received 1–3 prior lines of therapy (LOT), and had an Eastern Cooperative Oncology Group performance status <2. Treatments and outcomes were analyzed by number of prior LOT in the lenalidomide-refractory population. Time to next treatment (TTNT), progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier method. FindingsOut of 4764 patients, 915 patients (prior LOT, one [n=114]; two [n=462]; three [n=339]) met inclusion criteria. Median follow-up was 29.7 months (range 28·0–31·7). The overall response rate was 55·4%. Estimated median TTNT was 9·7 months, median PFS was 10.0 months, and median OS was 27·5 months. Response rates and PFS decreased as number of prior LOT increased. Prognostic factors for response, TTNT, PFS, and OS included International Staging System stage, baseline plasmacytoma status, baseline hemoglobin, anti-CD38–refractory status, and cytogenetic risk status. InterpretationLenalidomide-refractory patients treated with 1–3 prior LOT have poor PFS and OS, which generally worsen with each additional LOT, highlighting the need for new and effective treatments for this population.

BackgroundRare cancers correspond to approximately 200 clinical entities, which can be grouped into 12 families. Updated data are available for childhood and haematological cancers, ie, for only two of the 12 families of rare cancer. We provide incidence and survival for the remaining ten families of rare adult solid cancers (RAC), across 29 EU Member States and over time. We also evaluate the association between resources invested in health and survival from RACs. MethodsWe used the EUROCARE-6 database, which includes data from 108 cancer registries from 29 countries. We calculated incidence rates (IR) and 5-year relative survival (RS) for cases diagnosed during 2006–2013. We calculated 5-year RS in the follow-up period 2010–2014 using the period approach (last follow-up: December 31, 2014). We estimated changes in 5-year RS and IR over the period 2000–2013. We used a forest plot to report the differences in RS among countries with the highest and lowest health spending. ResultsRACs are heterogeneous in terms of incidence, survival, sex, and age distribution. Several RACs (eg, those of the hypopharynx, small intestine, and trachea) still have a 5-year RS <30%, which is not improving. Survival differs among European countries and is higher in countries with the greatest investments in health. The incidence of smoking-related RACs is decreasing but rising in HPV-related RACs. ConclusionInvestments in health and healthcare networks at national and European level can help increase the survival of RACs, especially those requiring centralisation of care (eg, bone sarcomas, penile cancer). These investments are critical considering that survival from RACs is not significantly improving. Our results unmask the heterogeneity of RACs, which needs to be considered in clinical trial design. Finally, our findings support the importance of prevention strategies for known risk factors such as smoking.