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Stratifying risk factors for follow-up

A comparison of recurrent and nonrecurrent colorectal cancer

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Abstract

INTRODUCTION: The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on finding reliable prognostic criteria for recurrence. However, such criteria are not universally accepted, and follow-up is often standardized for all patients without regard for each individual's level of risk of recurrence. Such a system of follow-up is not cost-effective. METHODS: A comparison of operative findings, pathologic features, and follow-up data of 1,731 cases of nonrecurrent colorectal cancer (821 colon, 910 rectum) with 357 cases of recurrent colorectal cancer (164 colon, 193 rectum) following potentially curative surgery was made, and results were analyzed to ascertain criteria for stratifying follow-up according to risk factors. RESULTS: Single-factor analysis showed that Dukes staging and tumor invasion were significantly associated with recurrence in both rectal and colon carcinoma. Tumor fixation and grading were additional significant factors in rectal cancer. Recurrence rates, time to recurrence, site of recurrence (locoregionalvs. distant), and pattern of metastatic spread were not significantly affected by original tumor site. Recurrence was not significantly affected by patient age and gender. Individual surgeon performance in this series had also no significant effects on tumor recurrence. With multivariate analysis only, Dukes staging and tumor invasion into adjacent tissues were found to be independent adverse prognostic factors for recurrence. CONCLUSIONS: Dukes staging and tumor penetration into adjacent tissues are the only significant adverse prognostic factors for tumor recurrence of colonic and rectal carcinoma. Tumor grade and tumor fixation are additional adverse prognostic factors in rectal cancer. Guidelines for follow-up may be based on these factors and follow-up thus stratified according to risk of developing recurrence.

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References

  1. 1.

    Hermanek P. Impact of surgeon's technique on outcome after treatment of rectal carcinoma. Dis Colon Rectum 1999;42:559–62.

    Google Scholar 

  2. 2.

    Simons AJ, Ker R, Groshen S,et al. Variations in treatment of rectal cancer. The influence of hospital type and caseload. Dis Colon Rectum 1997;40:641–6.

    Article  PubMed  Google Scholar 

  3. 3.

    Eu KW, Seow-Choen F, Ho JM, Ho YH, Leong AF. Local recurrence following rectal resection for cancer. J R Coll Surg Edinb 1998;43:393–6.

    PubMed  Google Scholar 

  4. 4.

    Bruinvels DJ, Stiggelbout AM, Kievit J, van Houwelingen HC, Habbema JD, van der Velde CJ. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg 1994;219:174–82.

    PubMed  Google Scholar 

  5. 5.

    Davies AH, Bernau F, Salisbury A, Souter RG. C-reactive protein in right iliac fossa pain. J R Coll Surg Edinb 1991;36:242–5.

    PubMed  Google Scholar 

  6. 6.

    Adloff M, Arnaud JP, Schloegel M, Thibaud D. Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum 1985;28:413–5.

    PubMed  Google Scholar 

  7. 7.

    Cass AW, Million RR, Pfaff WW. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.

    PubMed  Google Scholar 

  8. 8.

    Chapuis PH, Dent OF, Newland RC, Pheils MT, Smyth E, Colquoun K. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg 1985;72:698–702.

    PubMed  Google Scholar 

  9. 9.

    Danzi M, Ferulano GP, Abate S, Dilillo S, Califano G. Survival and locations of recurrence following abdomino-perineal resection for rectal cancer. J Surg Oncol 1986;31:235–9.

    PubMed  Google Scholar 

  10. 10.

    Galandiuk S, Wienand H, Moertel CG,et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1992;174:27–32.

    PubMed  Google Scholar 

  11. 11.

    Halvorsen TB, Seim E. Tumor site: a prognostic factor in colorectal cancer? Scand J Gastroenterol 1987;22:124–8.

    PubMed  Google Scholar 

  12. 12.

    McDermott FT, Hughes ES, Pihl EA, Milne BJ, Price AB. Influence of tumor differentiation on survival after resection for rectal cancer in a series of 1296 patients. Aust N Z J Surg 1984;54:53–8.

    PubMed  Google Scholar 

  13. 13.

    Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum 1997;40:15–24.

    Article  PubMed  Google Scholar 

  14. 14.

    Olson RM, Perencevich NP, Malcolm AW, Chaffey JT, Wison RE. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 1980;45:2969–74.

    PubMed  Google Scholar 

  15. 15.

    Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following curative surgery for large bowel cancer: I. The overall picture. Br J Surg 1984;71:12–6.

    PubMed  Google Scholar 

  16. 16.

    Pietra N, Sarli L, Sansebastiano G, Jotti GS, Peracchia A. Prognostic value of ploidy, cell proliferation kinetics, and conventional clinicopathologic criteria in patients with colorectal carcinoma: a prospective study. Dis Colon Rectum 1996;39:494–503.

    Article  PubMed  Google Scholar 

  17. 17.

    Philipshen JS, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.

    PubMed  Google Scholar 

  18. 18.

    Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum F, Hintz BL. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981;48:1492–5.

    PubMed  Google Scholar 

  19. 19.

    Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.

    PubMed  Google Scholar 

  20. 20.

    Takahashi T, Kato T, Kodaira S,et al. Prognostic factors of colorectal cancer. Am J Clin Oncol 1996;19:408–15.

    Article  PubMed  Google Scholar 

  21. 21.

    Tominaga T, Sakabe T, Koyama Y,et al. Prognostic factors for patients with colon or rectal carcinoma treated with resection only. Cancer 1996;78:403–8.

    Article  PubMed  Google Scholar 

  22. 22.

    Chung YF, Eu KW, Machin D,et al. Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 1998;85:1255–9.

    Article  PubMed  Google Scholar 

  23. 23.

    Sitzler PJ, Seow-Choen F, Ho YH, Leong AP. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients. Dis Colon Rectum 1997;40:1472–6.

    Article  PubMed  Google Scholar 

  24. 24.

    Kagda FH Nyam DC, Ho YH, Eu KW, Leong AF, Seow-Choen F. Surgery may be curative for patient with a localised perforation of rectal carcinoma. Br J Surg 1999;86:1448–50.

    Article  PubMed  Google Scholar 

  25. 25.

    McArdle CS, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. Br Med J 1991;302:1501.

    Google Scholar 

  26. 26.

    Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 1994;81:7–19.

    PubMed  Google Scholar 

  27. 27.

    Carlsson U, Lasson A, Ekelund G. Recurrence rates after curative surgery for rectal carcinoma, with special reference to their accuracy. Dis Colon Rectum 1987;30:431–4

    PubMed  Google Scholar 

  28. 28.

    Böhm B, Schwenk W, Hucke HP, Stock W. Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma? Dis Colon Rectum 1993;36:280.

    Article  PubMed  Google Scholar 

  29. 29.

    Kjeldsen BJ, Kronborg O, Fenger C, Jorgensen OD. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br J Surg 1997;84:666.

    Article  PubMed  Google Scholar 

  30. 30.

    Safi F, Link KH, Beger HG. Is follow-up of colorectal cancer patients worthwhile? Dis Colon Rectum 1993;36:636–44.

    PubMed  Google Scholar 

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Correspondence to F. Seow-Choen.

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Kraemer, M., Wiratkapun, S., Seow-Choen, F. et al. Stratifying risk factors for follow-up. Dis Colon Rectum 44, 815–821 (2001). https://doi.org/10.1007/BF02234700

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Key words

  • Follow-up
  • Adjuvant therapy
  • Surgeon impact
  • Prognostic factors