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Recurrence hazard of rectal cancer compared with colon cancer by adjuvant chemotherapy status: a nationwide study in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

Previous studies of stage III colon cancer using the hazard function demonstrated that the risk of recurrence in patients with adjuvant chemotherapy never exceeded that of patients without adjuvant chemotherapy. However, it is unclear whether the same can be said for rectal cancer patients and whether adjuvant chemotherapy reduces recurrence. This study aimed to compare the recurrence hazard of stage III rectal cancer with that of colon cancer by adjuvant chemotherapy status using the hazard function, a method that allows for the assessment of instantaneous risk of recurrence over time.

Methods

This retrospective nationwide study consisted of 10,356 patients with stage III colorectal cancer who underwent curative resection between January 1997 and December 2012 in Japan. Recurrence hazards of rectal and colon cancers were compared between patients treated with adjuvant chemotherapy and those who were not. Analyses in which recurrence was divided into local and distant recurrence were also performed.

Results

The hazard rate of recurrence in rectal cancer patients with adjuvant chemotherapy was consistently lower throughout the follow-up period, and the peak time of recurrence later, compared to patients without adjuvant chemotherapy (peaked at 15.7 vs. 7.1 months). Adjuvant chemotherapy also strongly suppressed distant recurrence but not local recurrence in rectal cancer patients. Similar results were observed in colon cancer patients.

Conclusions

Our results using nationwide real-world data in Japan suggest that, similar to what is observed in colon cancer patients, adjuvant chemotherapy delays the peak of recurrence and suppresses distant recurrence in stage III rectal cancer patients.

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Abbreviations

CRC:

Colorectal cancer

NCCN:

National Comprehensive Cancer Network

RFS:

Recurrence-free survival

TNM:

Tumor–node–metastasis

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Acknowledgements

This study is based on data from 24 hospitals, which are members of the Japanese Study Group for Postoperative Follow-up of CRC, as follows: Ichiro Takemasa (Sapporo Medical University); Kenichi Hakamada (Hirosaki University); Hitoshi Kameyama (Niigata University); Yasukimi Takii (Niigata Cancer Center Hospital); Hideki Ueno (National Defense Medical College); Heita Ozawa (Tochigi Cancer Center); Soichiro Ishihara (the University of Tokyo); Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital); Yukihide Kanemitsu (National Cancer Center Hospital); Michio Itabashi (Tokyo Women’s Medical University); Tomomichi Kiyomatsu (National Center for Global Health and Medicine); Yusuke Kinugasa (Tokyo Medical and Dental University); Koji Okabayashi (Keio University); Yojiro Hashiguchi (Teikyo University); Tadahiko Masaki (Kyorin University); Masahiko Watanabe (Kitasato University); Akio Shiomi (Shizuoka Cancer Center); Tsunekazu Hanai (Fujita Health University); Koji Komori (Aichi Cancer Center Hospital); Yoshiharu Sakai (Kyoto University); Masayuki Ohue (Osaka International Cancer Institute); Shingo Noura (Osaka Rosai Hospital); Naohiro Tomita (Hyogo College of Medicine); and Yoshito Akagi (Kurume University).

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan

    Yuka Ahiko, Dai Shida, Yozo Kudose, Yuya Nakamura, Konosuke Moritani & Yukihide Kanemitsu

  2. Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 1088639, Japan

    Yuka Ahiko & Dai Shida

  3. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Shinichi Yamauchi

  4. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Yuka Ahiko
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  2. Dai Shida
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  3. Yozo Kudose
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  4. Yuya Nakamura
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  5. Konosuke Moritani
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  6. Shinichi Yamauchi
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  7. Kenichi Sugihara
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  8. Yukihide Kanemitsu
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Japanese Study Group for Postoperative Follow-up of Colorectal Cancer

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Correspondence to Dai Shida.

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Ahiko, Y., Shida, D., Kudose, Y. et al. Recurrence hazard of rectal cancer compared with colon cancer by adjuvant chemotherapy status: a nationwide study in Japan. J Gastroenterol 56, 371–381 (2021). https://doi.org/10.1007/s00535-021-01771-6

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  • DOI: https://doi.org/10.1007/s00535-021-01771-6

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