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Identification of Recurrence—Predictive Indicators in Stage I Colorectal Cancer

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Abstract

Background

Patients with stage I colorectal cancer (CRC) rarely experience recurrences; therefore, few risk factors for recurrence are known. This study was designed to evaluate oncologic outcomes of patients with stage I CRC and to identify risk factors for recurrence after curative surgery.

Methods

A retrospective cohort of 860 patients from a single institution who underwent curative surgery for stage I CRC between July 1995 and June 2010 was enrolled. Patients who were diagnosed with hereditary, synchronous, or metachronous cancer and those who received preoperative chemoradiotherapy were excluded. Patients from whom fewer than 12 lymph nodes were retrieved were also excluded.

Results

The 860 patients included 402 (46.7%) with colon tumors and 458 (53.3%) with rectal tumors. Thirty-five patients (4.1%) experienced recurrences; local and systemic recurrence rates were 1.1 and 3.0%, respectively. The 5-year overall survival and recurrence-free survival (RFS) rates were 93.5 ± 0.8% and 95.7 ± 0.8%, respectively. Multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) concentration ≥6 ng/mL (hazard ratio [HR] 3.354, 95% confidence interval [CI] 1.373–8.195, p = 0.008) and lymphovascular invasion (LVI) (HR 2.676, 95% CI 1.097–6.531, p = 0.031) were independent risk factors for RFS.

Conclusions

The overall recurrence rate among patients with stage I CRC after curative surgery was 4.1%. Elevated serum CEA and LVI were significantly associated with recurrence. Large-scale, multicenter studies are needed to confirm the prognostic value of these risk factors.

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References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29

    Article  PubMed  Google Scholar 

  2. Jung KW, Won YJ, Kong HJ et al (2015) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 47:127–141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mandel JS, Bond JH, Church TR et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328:1365–1371

    Article  CAS  PubMed  Google Scholar 

  4. Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME (2006) Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA 296:2815–2822

    Article  PubMed  Google Scholar 

  5. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  6. National Cancer Information Center (2016) http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_040303000000. Accessed 1 June 2016

  7. Wichmann MW, Muller C, Hornung HM, Lau-Werner U, Schildberg FW, Colorectal Cancer Study Group (2002) Results of long-term follow-up after curative resection of Dukes A colorectal cancer. World J Surg 26:732–736

    Article  PubMed  Google Scholar 

  8. Teloken PE, Ransom D, Faragher I, Jones I, Gibbs P, Platell C (2016) Recurrence in patients with stage I colorectal cancer. ANZ J Surg 86:49–53

    Article  PubMed  Google Scholar 

  9. Keum MA, Lim SB, Kim SA et al (2012) Clinicopathologic factors affecting recurrence after curative surgery for stage I colorectal cancer. J Korean Soc Coloproctol 28:49–55

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Kim JC, Han MS, Lee HK et al (1999) Distribution of carcinoembryonic antigen and biologic behavior in colorectal carcinoma. Dis Colon Rectum 42:640–648

    Article  CAS  PubMed  Google Scholar 

  12. Kim JE, Hong YS, Kim HJ et al (2015) Defective mismatch repair status was not associated with DFS and OS in stage II colon cancer treated with adjuvant chemotherapy. Ann Surg Oncol 22:S630–S637

    Article  PubMed  Google Scholar 

  13. Yoo C, Koh YW, Park YS et al (2015) Prognostic relevance of p53 overexpression in gastrointestinal stromal tumors of the small intestine: potential implication for adjuvant treatment with imatinib. Ann Surg Oncol 22:S362–S369

    Article  PubMed  Google Scholar 

  14. Lee JL, Yu CS, Kim CW, Yoon YS, Lim SB, Kim JC (2013) Chronological improvement in survival following rectal cancer surgery: a large-scale, single-center study. World J Surg 37:2693–2699

    Article  PubMed  Google Scholar 

  15. Sticca RP, Rodriguez-Bigas M, Penetrante RB, Petrelli NJ (1996) Curative resection for stage I rectal cancer: natural history, prognostic factors, and recurrence patterns. Cancer Invest 14:491–497

    Article  CAS  PubMed  Google Scholar 

  16. Blumberg D, Paty PB, Picon AI et al (1998) Stage I rectal cancer: identification of high-risk patients. J Am Coll Surg 186:574–579; discussion 579–580

  17. Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994

    CAS  PubMed  Google Scholar 

  18. Duffy MJ (2001) Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful? Clin Chem 47:624–630

    CAS  PubMed  Google Scholar 

  19. Lim SB, Yu CS, Jang SJ, Kim TW, Kim JH, Kim JC (2010) Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. Dis Colon Rectum 53:377–384

    Article  PubMed  Google Scholar 

  20. Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N (1983) Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum 26:613–617

    Article  CAS  PubMed  Google Scholar 

  21. Shirouzu K, Isomoto H, Kakegawa T (1993) Prognostic evaluation of perineural invasion in rectal cancer. Am J Surg 165:233–237

    Article  CAS  PubMed  Google Scholar 

  22. Liebig C, Ayala G, Wilks J et al (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27:5131–5137

    Article  PubMed  PubMed Central  Google Scholar 

  23. Watanabe K, Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y (2011) Predictive factors for pulmonary metastases after curative resection of rectal cancer without preoperative chemoradiotherapy. Dis Colon Rectum 54:989–998

    Article  PubMed  Google Scholar 

  24. Lee JL, Yu CS, Kim TW, Kim JH, Kim JC (2015) Rate of pulmonary metastasis varies with location of rectal cancer in the patients undergoing curative resection. World J Surg 39:759–768

    Article  PubMed  Google Scholar 

  25. Willett CG, Lewandrowski K, Donnelly S et al (1992) Are there patients with stage I rectal carcinoma at risk for failure after abdominoperineal resection? Cancer 69:1651–1655

    Article  CAS  PubMed  Google Scholar 

  26. Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919

    Article  PubMed  Google Scholar 

  27. Liang J, Fazio V, Lavery I et al (2015) Primacy of surgery for colorectal cancer. Br J Surg 102:847–852

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by Grants (to J.C. Kim) from the Korea Research Foundation (2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, and the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), Ministry of Health, Welfare, and Family Affairs, Republic of Korea.

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Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jun Ho Lee, Jong Lyul Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu & Jin Cheon Kim

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  1. Jun Ho Lee
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  2. Jong Lyul Lee
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  3. In Ja Park
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  4. Seok-Byung Lim
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Correspondence to Jin Cheon Kim.

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Lee, J.H., Lee, J.L., Park, I.J. et al. Identification of Recurrence—Predictive Indicators in Stage I Colorectal Cancer. World J Surg 41, 1126–1133 (2017). https://doi.org/10.1007/s00268-016-3833-2

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