Clinicopathological Features of Stage I-III Colorectal Cancer Recurrence Over 5 Years After Radical Surgery Without Receiving Neoadjuvant Therapy: Evidence From a Large Sample Study.

Dakui Luo,Sanjun Cai,Qi Liu,Yufei Yang,Zezhi Shan,Qingguo Li,Xinxiang Li

doi:10.3389/fsurg.2021.666400

Abstract

Late recurrence (5 or more years) after radical resection of colorectal cancer (CRC) is rare. This study aims to investigate the features of late recurrence in stage I–III CRC. A total of 9,754 stage I–III patients with CRC who underwent radical surgery without receiving neoadjuvant therapy, at the Fudan University Shanghai Cancer Center (FUSCC), were enrolled in this study. These patients were divided into three groups: early recurrence (3 months−2 years), intermediate recurrence (2–5 years), and late recurrence (over 5 years). The median duration of follow-up was 53.5 ± 30.1 months. A total of 2,341 (24.0%) patients developed recurrence. The late recurrence rate was 11.7%. Patients with a higher risk of late recurrence were more likely to be older, to be at the T4 stage, to have a higher degree of colon cancer, to have a lower frequency of signet ring cell carcinoma, to have fewer poorly differentiated tumors, to be at the early stage of CRC, along with less perineural and vascular invasions. Multivariate logistic regression analysis identified age, differentiation, T stage, N stage, perineural, and vascular invasions as independent factors for late recurrence. Late recurrent CRC has some distinctive characteristics. Although recurrence over 5 years after surgery is infrequent, an enhanced follow-up is still needed for the selected patients after 5 years.

Highlights

Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related mortality worldwide [1]
The inclusion criteria were as follows: [1] patients had stage I–III diseases, patients in the T stage or the undetermined TNM stage were excluded; [2] patients had undergone curative surgery; [3] patients did not undergo neoadjuvant therapy; [4] the histology presented with adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma; [5] survival information was available; and [6] the disease-free, survival period was longer than 3 months
These patients were divided into three groups: early recurrence (3 months−2 years, N = 1,187), intermediate recurrence (2–5 years, N = 849), and late recurrence, after initial surgery

Summary

Introduction

Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related mortality worldwide [1]. For resectable non-metastatic CRC, surgery with bowel resection and removal of the regional lymph nodes is preferred. Adjuvant therapy is administrated according to the postoperative pathological stage. Posttreatment surveillance is regularly performed to identify a recurrence that is potentially resectable for the cure. About 25–40% of patients still suffer tumor recurrence during follow-up due to high spatiotemporal heterogeneity [2,3,4]

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