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. 2018 Jul;61(7):803-808.
doi: 10.1097/DCR.0000000000001002.

Risk Factors for Peritoneal Recurrence in Stage II to III Colon Cancer

Shuhei Mayanagi  1 , Kosuke Kashiwabara  2 , Michitaka Honda  3 , Koji Oba  2 , Toru Aoyama  4 , Mitsuro Kanda  5 , Hiromichi Maeda  6 , Chikuma Hamada  7 , Sotaro Sadahiro  8 , Junichi Sakamoto  9   10 , Shigetoyo Saji  10 , Takaki Yoshikawa  11
Affiliations

Risk Factors for Peritoneal Recurrence in Stage II to III Colon Cancer

Shuhei Mayanagi et al. Dis Colon Rectum. 2018 Jul.

Abstract

Background: Most previous reports to analyze risk factors for peritoneal recurrence in patients with colon cancer have been observational studies of a population-based cohort.

Objective: This study aimed to determine the risk factors for peritoneal recurrence in patients with stage II to III colon cancer who underwent curative resection.

Design: This was a pooled analysis using a combined database obtained from 3 large phase III randomized trials (N = 3714).

Settings: Individual patient data were collected from the Japanese Foundation for Multidisciplinary Treatment of Cancer clinical trials 7, 15, and 33, which evaluated the benefits of postoperative 5-fluorouracil-based adjuvant therapies in patients with locally advanced colorectal cancer.

Patients: We included patients who had stage II to III colon cancer and underwent curative resection with over D2 lymph node dissection.

Main outcome measures: Main outcomes measured were risk factors for peritoneal recurrence without other organ metastasis after curative surgery.

Results: Peritoneal recurrence occurred in 2.3% (86/3714) of all patients undergoing curative resection. Mean duration from operation to peritoneal recurrence was 17.0 ± 10.3 months. Of these patients with peritoneal recurrence, 29 patients (34%) had recurrence in ≥1 other organ. Multivariate analysis showed that age (≥60 y: HR = 0.531; p = 0.0182), pathological T4 (HR = 3.802; p < 0.0001), lymph node involvement (HR = 3.491; p = 0.0002), and lymphadenectomy (D2: HR = 1.801; p = 0.0356) were independent predictors of peritoneal recurrence. The overall survival was lower in patients who developed peritoneal recurrence than in those with other recurrence (HR = 1.594; p = 0.002).

Limitations: The regimens of adjuvant chemotherapy were limited to oral 5-fluorouracil.

Conclusions: Our findings clarified the risk factors for peritoneal recurrence in patients who underwent curative resection for colon cancer. See Video Abstract at http://links.lww.com/DCR/A609.

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Figures

FIGURE 1.
FIGURE 1.
Flow diagram. We included patients who had stage II to III colon cancer and underwent curative resection with over D2 lymph node dissection. In total, 3714 patients were included in the present study.
FIGURE 2.
FIGURE 2.
The Kaplan–Meier graph of overall survival (OS). The OS is lower among patients with recurrent peritoneal carcinomatosis than among those with other recurrence (p = 0.002).
See this image and copyright information in PMC

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