Abstract
Purpose
Data regarding risk factors for recurrence in stage I colorectal cancer patients are limited. The aim of this study was to clarify the existence of a high-recurrence-risk population among stage I colorectal cancer patients.
Methods
This analysis included 7,539 stage I colorectal cancer patients treated between 1997 and 2012 at 24 leading hospitals in Japan. Risk factors for time to recurrence were evaluated using a Cox proportional hazards model, and a high-risk group for recurrence was identified. Prognostic outcomes of high-risk stage I colorectal cancer patients were compared with those of low-risk stage I and stage II patients.
Results
Multivariable analyses identified left-sided location (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.09–2.58), T2 tumors (HR: 1.80, 95% CI: 1.21–2.66), and lymphatic invasion (HR: 1.55, 95% CI: 1.05–2.28) as risk factors for recurrence in stage I colon cancer, and patients with these three risk factors were classified as high risk. For stage I rectal cancer, patients with poor differentiation (HR: 2.86, 95% CI: 1.21–5.69), T2 tumors (HR: 1.53, 95% CI: 1.07–2.23), and venous invasion (HR: 1.51, 95% CI: 1.08–2.13) were identified as high risk. The Kaplan–Meier analysis of cumulative recurrence rate and recurrence-free survival revealed that the high-risk stage I colorectal cancer patients have poorer clinical outcomes than the low-risk patients.
Conclusion
Although stage I colorectal cancer patients generally have a favorable prognosis after curative surgery, poorer prognosis was observed in high-risk stage I colorectal cancer patients than in low-risk patients.
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Acknowledgements
The authors thank all the members of the institutions participating in the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer: I. Takemasa (Sapporo Medical University), K. Hakamada (Hirosaki University), H. Kameyama (Niigata University), Y. Takii (Niigata Cancer Center Hospital), H. Ueno (National Defense Medical College), H. Ozawa (Tochigi Cancer Center), S. Ishihara (Tokyo University), K. Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital), Y. Kanemitsu (National Cancer Center Hospital), M. Itabashi (Tokyo Women’s Medical University), T. Kiyomatsu (National Center for Global Health and Medicine), Y. Kinugasa (Tokyo Medical and Dental University), K. Okabayashi (Keio University), Y. Hashiguchi (Teikyo University), T. Masaki (Kyorin University), M. Watanabe (Kitasato University), A. Shiomi (Shizuoka Cancer Center), T. Hanai (Fujita Health University), K. Komori (Aichi Cancer Center Hospital), M. Ohue (Osaka International Cancer Institute), S. Noura (Osaka Rosai Hospital ), N. Tomita (Hyogo College of Medicine), and Y. Akagi (Kurume University).
Funding
This work was supported by the grant from Kondou Kinen Medical Foundation. We received payment for language editing and proofreading of this manuscript. The funding source had no role in the design, practice, or analysis of this study.
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Fukui, Y., Hida, K., Hoshino, N. et al. Identification of high-risk stage I colon and rectal cancer patients: a retrospective analysis of a large Japanese cohort. Int J Colorectal Dis 37, 1403–1410 (2022). https://doi.org/10.1007/s00384-022-04161-3
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DOI: https://doi.org/10.1007/s00384-022-04161-3