Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.50
Peer-review started: October 27, 2020
First decision: November 30, 2020
Revised: December 9, 2020
Accepted: December 17, 2020
Article in press: December 17, 2020
Published online: January 27, 2021
Colorectal cancer is a common tumor with a quite high-related mortality. Despite the used curative treatments, patients will develop cancer recurrence in up to 50% of the cases and/or other primary neoplasms. Although most of the recurrences are discovered within 3 years from the first treatment, a small percentage is found after 5 years. The early detection of recurrence is crucial to allow further therapies improving patients’ survival. Several follow-up programs have been developed but the optimal one is far from being established.
To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.
Perioperative and long-term data of all consecutive patients surgically treated with curative intent, from January 2006 to June 2009, for colorectal adenocar-cinoma, were retrospectively reviewed to find potential prognostic factors associated with: (1) Recurrence incidence; (2) Incidence of an early (within 3 years from surgery) or late recurrence; and (3) Different sites of recurrence. In addition, the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.
Our study included 234 patients. The median follow-up period has been 119 ± 46.2 mo. The recurrence rate has been 25.6%. Patients with a higher chance to develop recurrence had also the following characteristics: Higher levels of preoperative glycemia and carcinoembryonic antigen, highest anaesthesiologists Score score, occlusion, received a complex operation performed with an open technique, after a longer hospital stay, and showed advanced tumors. The independent prognostic factors for recurrence were the hospital stay, N stage 2, and M stage 1 (multivariate analysis). Younger ages were significantly associated with an early recurrence onset. Patients that received intermediate colectomies or segmental resections, having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence, while metastatic diseases at diagnosis were linked with local recurrence. Neoadjuvant treatments showed lung recurrence. Finally, bigger tumors and higher lymph node ratio were associated with peritoneal recurrence (marginally significant). Thirty patients developed a second malignancy during the follow-up time.
Several prognostic factors should be considered for tailored follow-up programs, eventually, beyond 5 years from the first treatment.
Core Tip: In this retrospective study, several potential prognostic factors for recurrence, timing, and recurrence sites have been evaluated in patients who received curative colorectal surgery for adenocarcinoma with a potential minimum follow-up of 10 years. The independent prognostic factors for recurrence were the hospital stay, N stage 2, and M stage 1. Of note, younger ages were significantly associated with an early onset of recurrence. Some prognostic factors have been found for each site of recurrence: Liver, local, lung, and peritoneum. Thirty patients developed a second malignancy during the follow-up period. These findings may help in providing a tailored follow-up program.