Recurrence in patients with stage I colorectal cancer

Abstract

Background: Outcomes of patients with stage I colorectal cancer submitted to surgery with curative intent have not been thoroughly explored in contemporary series.

Methods: All patients with colon or rectal adenocarcinoma who underwent resection from the St John of God Hospital (1996-2013) and BioGrid (1991-2013) databases were identified. Patients submitted to local excision, polypectomies or neoadjuvant treatment were excluded. Outcomes included recurrence (combined local and systemic), recurrence-free and overall survival, and survival after recurrence.

Results: A total of 1193 patients with stage I disease were included. Median age was 67 (interquartile range 59-75) and median follow-up was 3.2 years (interquartile range 1.4-5.8). Five-year recurrence rate was 7.1% (95% confidence interval (CI) 5.4-9.4%; 5.0% for colon and 11.1% for rectal cancer). Rectal location was an independent predictor of recurrence (hazard ratio (HR) 1.97, 95% CI 1.09-3.55; P = 0.024). Lymphovascular invasion was an independent predictor of recurrence only in patients with rectal cancer (HR 3.0, 95% CI 1.2-7.6; P = 0.018). Five-year recurrence-free survival was 83.2% (95% CI 80.3-85.4%). Age (HR 1.05, 95% CI 1.03-1.07; P < 0.001), elective surgery (HR 0.41, 95% CI 0.21-0.80; P = 0.011) and the American Society of Anesthesiologists (ASA) score (HR 3.08, 95% CI 1.51-6.31; P < 0.001) were independently associated with recurrence-free survival. Median survival after recurrence was 41 months. Resection of recurrence was attempted in 39% of patients.

Conclusion: Patients with stage I colorectal cancers still have a clinically significant risk of recurrence. Rectal location is independently associated with higher recurrence. Age, elective surgery and ASA are independently associated with recurrence-free survival. A significant proportion of patients with recurrence underwent further resection.

Keywords: colon cancer; rectal cancer; recurrence; surveillance.