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Predictive factors for distant recurrence of colorectal cancer in patients after curative resection for stage I–III colorectal cancer in Australia

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Abstract

Purpose

Distant recurrence is a devastating occurrence after colorectal cancer resection. This study aimed to identify the risk factors for distant recurrence following surgery.

Methods

All consecutive colorectal cancer resections with curative intent were included from a prospectively maintained colorectal cancer database. The primary outcome was to identify predictive factors for distant recurrence of colorectal cancer.

Results

A total of 670 eligible cases were identified with 88 (13.1%) developing distant recurrence during the follow-up period. The median time to distant recurrence was 1.2 years with the most common sites of distant recurrence being the lung (44.3%) and liver (44.3%). Predictive factors for distant recurrence in colon cancer included a high tumor, nodal, and overall stage of the primary cancer (p < 0.001 for all). Surgical complications (p = 0.007), including anastomotic leak (p = 0.023), were associated with a higher risk of developing distant recurrence in rectal cancer patients. Independent variables associated with distant recurrence included tumor stage (OR 1.61, p = 0.011), nodal stage (OR 2.18, p < 0.001), and both KRAS (OR 11.04, p < 0.001) and MLH/PMS2 (OR 0.20, p = 0.035) genetic mutations. Among patients with distant recurrence, treatment with surgery conferred the best survival, with patients < 50 years of age having the best overall 5-year survival.

Conclusion

Predictive factors for distant recurrence include advanced tumor and nodal stages, and the presence of KRAS and MLH/PSM2 mutations. Clinicians should be cognizant of these risk factors, and instate close surveillance plans for patients exhibiting these features.

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Data availability

Data will be made available on reasonable request.

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Author information

Author notes

  1. Swetha Prabhakaran and Joseph C. Kong have contributed equally to this study.

Authors and Affiliations

  1. Department of Colorectal Surgery, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Swetha Prabhakaran, Joseph C. Kong, Martin Chin, Peter Carne, Chip Farmer, Stewart Skinner, Satish K. Warrier & Stephen Bell

  2. Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Joseph C. Kong & Satish K. Warrier

  3. University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Joseph C. Kong

  4. Monash University, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Martin Chin, Peter Carne, Chip Farmer, Stewart Skinner & Stephen Bell

Authors
  1. Swetha Prabhakaran
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  2. Joseph C. Kong
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  8. Stephen Bell
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Contributions

SP and JCK, All authors contributed to the interpretation of data: Substantial contributions to conception and design, acquisition of data, analysis, and interpretation of data.

All authors: Substantial contributions to conception and design, and interpretation of data.

All authors: Drafting the article or revising it critically for important intellectual content.

All authors: Final approval of the version to be published.

Corresponding author

Correspondence to Swetha Prabhakaran.

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Ethics approval was obtained from the Alfred Health Ethics Committee.

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The authors declare no competing conflicts.

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Swetha Prabhakaran and Joseph C. Kong are co-first authors.

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Prabhakaran, S., Kong, J.C., Chin, M. et al. Predictive factors for distant recurrence of colorectal cancer in patients after curative resection for stage I–III colorectal cancer in Australia. Langenbecks Arch Surg 406, 2789–2796 (2021). https://doi.org/10.1007/s00423-021-02273-y

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  • DOI: https://doi.org/10.1007/s00423-021-02273-y

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