Thoracic recurrence in patients with curatively-resected colorectal cancer: incidence, risk factors, and value of chest CT as a postoperative surveillance tool

  • J. H. Lee
  • Chang Min ParkEmail author
  • I. Joo
  • Y. J. Suh
  • E. J. Hwang
  • H. Kim
  • J. M. Goo



To investigate the incidence of thoracic recurrence and the diagnostic value of chest CT for postoperative surveillance in curatively-resected colorectal cancer (CRC) patients.


This retrospective study consisted of 648 CRC patients (M:F, 393:255; mean age, 66.2 years) treated with curative surgery between January 2010 and December 2012. The presence of CRC recurrence over follow-ups was analysed and recurrence-free survival and risk factors of recurrence were assessed using Kaplan–Meier analysis with log-rank test and Cox-regression analysis, respectively.


Over a median follow-up of 57 months, thoracic recurrence occurred in 8.0% (52/648) of patients with a median recurrence-free survival rate of 19.5 months. Among the 52 patients with thoracic recurrence, 18 (2.7%) had isolated thoracic recurrence, and only five (0.8%) were diagnosed through chest CT. Risk factors of overall thoracic recurrence included age, positive resection margin, presence of venous invasion, positive pathologic N-class, and presence of abdominal recurrence (odds ratio [OR] = 1.78, 19.691, 2.993, 2.502, and 31.137; p = 0.045, 0.004, 0.001, 0.005, and p < 0.001, respectively). As for isolated thoracic recurrence, serum carcinoembryonic antigen level ≥ 5 ng/mL during postoperative follow-up (OR = 9.112; p < 0.001) was demonstrated to be the only predictive factor. There were no thoracic recurrences in patients with CRC stages 0 and I.


In patients with curatively-resected CRCs, routine surveillance using chest CT may be of limited value, particularly in those with CRC stages 0 or I, as recurrence only detectable through chest CT was shown to be rare.

Key Points

• Postoperative thoracic recurrence only detectable through chest CT was shown to be rare.

• There were no thoracic recurrences in colorectal cancers stage 0 and I.

• Postoperative surveillance chest CT is of limited value in patients with curatively resected colorectal cancers.


Colorectal cancer Thorax Recurrence Follow-up studies Tomography, x-ray computed 



Carcinoembryonic antigen


Colorectal cancer



This study has received funding by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C3390).

Compliance with ethical standards


The scientific guarantor of this publication is Chang Min Park, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board of Seoul National University Hospital.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulKorea
  2. 2.Armed Forces Seoul HospitalSeoulKorea
  3. 3.Cancer Research InstituteSeoul National UniversitySeoulKorea

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