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Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study

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Abstract

Background

Because the rate of recurrence after curative resection for T1 colorectal cancer is low, the characteristics of recurrence remain obscure. This multicenter study attempted to clarify the characteristics of recurrence after curative resection for T1 colorectal cancer.

Methods

We analyzed the associations between recurrence and various clinicopathological features in 798 patients who had undergone curative resection alone for T1 colorectal cancer at 14 hospitals between 1991 and 1996.

Results

The rate of lymph node metastasis (LNM) in patients with T1 colorectal cancer was 10.5% (84/798), and 18 (2.3%) of the 798 patients developed recurrence during the median follow-up of 7.8 years. The recurrence rates in patients with colon cancer with and without LNM were 3.6 and 1.3%, respectively (p = 0.19). These rates in patients with cancer of the rectum were 25.0 and 1.1% (p < 0.0001). Among various parameters, histological grade (p < 0.0001), location (p = 0.025), LNM (p < 0.0001), and venous invasion (p = 0.0013) were risk factors for recurrence. Among them, LNM (p = 0.0008) and histological grade (p = 0.041) were independent risk factors for recurrence after curative resection for T1 colorectal cancer. Time to recurrence was more likely to be shorter for patients with, than without nodal involvement. In patients with an unfavorable histological grade, all recurrences developed within 1 year.

Conclusions

The recurrence rate after curative resection for node-negative T1 colorectal cancer was very low. The effectiveness of surveillance to detect recurrence after curative resection for T1 colorectal cancer should be validated in further studies.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71–96.

    Article  PubMed  Google Scholar 

  2. Kotake K, Honjo S, Sugihara K, Kato T, Kodaira S, Takahashi T, et al. Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer, Japan. Dis Colon Rectum. 2003;46(10 Suppl):S32–43.

    PubMed  Google Scholar 

  3. Muto T, Kotake K, Koyama Y. Colorectal cancer statistics in Japan: data from JSCCR registration, 1974–1993. Int J Clin Oncol. 2001;6(4):171–6.

    Article  CAS  PubMed  Google Scholar 

  4. Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006;63(2):243–9.

    Article  PubMed  Google Scholar 

  5. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25(7):455–61.

    Article  CAS  PubMed  Google Scholar 

  6. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66(5):966–73.

    Article  PubMed  Google Scholar 

  7. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66(1):100–7.

    Article  PubMed  Google Scholar 

  8. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.

    Article  PubMed  Google Scholar 

  9. Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141(1):67–75.

    Article  PubMed  Google Scholar 

  10. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45(2):200–6.

    Article  PubMed  Google Scholar 

  11. Nivatvongs S, Rojanasakul A, Reiman HM, Dozois RR, Wolff BG, Pemberton JH, et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum. 1991;34(4):323–8.

    Article  CAS  PubMed  Google Scholar 

  12. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127(2):385–94.

    Article  PubMed  Google Scholar 

  13. Blumberg D, Paty PB, Picon AI, Guillem JG, Klimstra DS, Minsky BD, et al. Stage I rectal cancer: identification of high-risk patients. J Am Coll Surg. 1998;186(5):574–9. (discussion pp 579–80).

    Article  CAS  PubMed  Google Scholar 

  14. Cooper HS, Deppisch LM, Gourley WK, Kahn EI, Lev R, Manley PN, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology. 1995;108(6):1657–65.

    Article  CAS  PubMed  Google Scholar 

  15. Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser, Temple LK, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg. 2005;242(4):472–7. (discussion 477–9).

    PubMed  Google Scholar 

  16. Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum. 2005;48(7):1380–8.

    Article  PubMed  Google Scholar 

  17. Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff RD, Rothenberger DA. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg. 2000;231(3):345–51.

    Article  CAS  PubMed  Google Scholar 

  18. Hager T, Gall FP, Hermanek P. Local excision of cancer of the rectum. Dis Colon Rectum. 1983;26(3):149–51.

    Article  CAS  PubMed  Google Scholar 

  19. You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg. 2007;245(5):726–33.

    Article  PubMed  Google Scholar 

  20. Kobayashi H, Mochizuki H, Kato T, Mori T, Kameoka S, Shirouzu K, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol. 2010;17(4):973–80.

    Article  PubMed  Google Scholar 

  21. Weiss L, Grundmann E, Torhorst J, Hartveit F, Moberg I, Eder M, et al. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol. 1986;150(3):195–203.

    Article  CAS  PubMed  Google Scholar 

  22. Makela JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg. 1995;130(10):1062–7.

    CAS  PubMed  Google Scholar 

  23. Schoemaker D, Black R, Giles L, Toouli J. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology. 1998;114(1):7–14.

    Article  CAS  PubMed  Google Scholar 

  24. Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23(34):8706–12.

    Article  PubMed  Google Scholar 

  25. Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg. 2002;236(4):416–21. discussion 421.

    Article  PubMed  Google Scholar 

  26. Wolmark N, Fisher B, Wieand HS. The prognostic value of the modifications of the Dukes’ C class of colorectal cancer. An analysis of the NSABP clinical trials. Ann Surg. 1986;203(2):115–22.

    Article  CAS  PubMed  Google Scholar 

  27. Cranley JP, Petras RE, Carey WD, Paradis K, Sivak MV. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology. 1986;91(2):419–27.

    CAS  PubMed  Google Scholar 

  28. Harrison JC, Dean PJ, el-Zeky F, Vander Zwaag R. From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol. 1994;25(5):498–505.

    Article  CAS  PubMed  Google Scholar 

  29. Michelassi F, Ayala JJ, Balestracci T, Goldberg R, Chappell R, Block GE. Verification of a new clinicopathologic staging system for colorectal adenocarcinoma. Ann Surg. 1991;214(1):11–8.

    Article  CAS  PubMed  Google Scholar 

  30. Mulcahy HE, Skelly MM, Husain A, O’Donoghue DP. Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg. 1996;83(1):46–50.

    Article  CAS  PubMed  Google Scholar 

  31. Muller S, Chesner IM, Egan MJ, Rowlands DC, Collard MJ, Swarbrick ET, et al. Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum. Gut. 1989;30(10):1385–91.

    Article  CAS  PubMed  Google Scholar 

  32. Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser CM, Rossini FP. Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential. Cancer. 1989;64(9):1937–47.

    Article  CAS  PubMed  Google Scholar 

  33. Tanaka S, Haruma K, Teixeira CR, Tatsuta S, Ohtsu N, Hiraga Y, et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol. 1995;30(6):710–7.

    Article  CAS  PubMed  Google Scholar 

  34. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38(12):1286–95.

    Article  CAS  PubMed  Google Scholar 

  35. Masaki T, Sugiyama M, Matsuoka H, Abe N, Izumisato Y, Goto A, et al. Clinical utility of grading criteria for submucosal invasion in the prognosis of T1 colorectal carcinomas. J Gastroenterol. 2003;38(1):37–44.

    Article  PubMed  Google Scholar 

  36. Sakuragi M, Togashi K, Konishi F, Koinuma K, Kawamura Y, Okada M, et al. Predictive factors for lymph node metastasis in T1 stage colorectal carcinomas. Dis Colon Rectum. 2003;46(12):1626–32.

    Article  PubMed  Google Scholar 

  37. Hase K, Shatney CH, Mochizuki H, Johnson DL, Tamakuma S, Vierra M, et al. Long-term results of curative resection of “minimally invasive” colorectal cancer. Dis Colon Rectum. 1995;38(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  38. Kurokawa S, Arimura Y, Yamamoto H, Adachi Y, Endo T, Sato T, et al. Tumour matrilysin expression predicts metastatic potential of stage I (pT1) colon and rectal cancers. Gut. 2005;54(12):1751–8.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hirotoshi Kobayashi & Kenichi Sugihara

  2. Department of Surgery, National Defense Medical College, Tokorozawa, Japan

    Hidetaka Mochizuki

  3. Department of Surgery, School of Medicine, Hirosaki University, Hirosaki, Japan

    Takayuki Morita

  4. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan

    Kenjiro Kotake

  5. Division of General and Gastroenterological Surgery, Department of Surgery (Omori), School of Medicine, Toho University, Tokyo, Japan

    Tatsuo Teramoto

  6. Department of Surgery II, Tokyo Women’s Medical University, Tokyo, Japan

    Shingo Kameoka

  7. Department of Surgery, International Medical Center of Japan, Tokyo, Japan

    Yukio Saito

  8. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Keiichi Takahashi

  9. Department of Surgery, Self-Defense Forces Central Hospital, Tokyo, Japan

    Kazuo Hase

  10. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan

    Masatoshi Oya

  11. Department of Surgery, Fujita Health University, Toyoake, Japan

    Koutarou Maeda

  12. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Takashi Hirai

  13. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Masao Kameyama

  14. Department of Surgery, Kurume University School of Medicine, Kurume, Japan

    Kazuo Shirouzu

Authors
  1. Hirotoshi Kobayashi
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  2. Hidetaka Mochizuki
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  3. Takayuki Morita
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  4. Kenjiro Kotake
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  6. Shingo Kameoka
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  7. Yukio Saito
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  8. Keiichi Takahashi
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  9. Kazuo Hase
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  10. Masatoshi Oya
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  11. Koutarou Maeda
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  12. Takashi Hirai
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  13. Masao Kameyama
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  14. Kazuo Shirouzu
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  15. Kenichi Sugihara
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Corresponding author

Correspondence to Hirotoshi Kobayashi.

Additional information

All authors are members of the Study Group of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) on Postsurgical Surveillance of Colorectal Cancer.

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Kobayashi, H., Mochizuki, H., Morita, T. et al. Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study. J Gastroenterol 46, 203–211 (2011). https://doi.org/10.1007/s00535-010-0341-2

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  • DOI: https://doi.org/10.1007/s00535-010-0341-2

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