Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study

Abstract

This study aimed to assess whether surveillance intensity is associated with recurrence and survival in colorectal cancer (CRC) patients. Overall, 3794 patients with pathologic stage I-III CRC who underwent radical surgery between January 2012 and December 2014 were examined. Surveillance comprised abdominopelvic computed tomography (CT) every 6 months and chest CT annually for 5 years. Patients who underwent more than and less than an average of three imaging examinations annually were assigned to the high-intensity (HI) and low-intensity (LI) groups, respectively. Demographics were similar in both groups. T and N stages were higher and perineural and lymphovascular invasion were more frequent in the HI group (p < 0.001 each). The mean overall survival (OS) was similar for both groups; however, recurrence-free survival (RFS) was longer (p < 0.001) and post-recurrence survival (PRS) was shorter (p = 0.024) in the LI group. In the multivariate analysis, surveillance intensity was associated with RFS (p < 0.001) in contrast to PRS (p = 0.731). In patients with high recurrence risk predicted using the nomogram, OS was longer in the HI group (p < 0.001). A higher imaging frequency in patients at high risk of recurrence could be expected to lead to a slight increase in PRS but does not improve OS. Therefore, rather than increasing the number of CT scans in high-risk patients, other imaging modalities or innovative approaches, such as liquid biopsy, are required.

Keywords: colorectal cancer; recurrence; surveillance; survival.

Figure 1

Kaplan–Meier analyses of (A) recurrence-free survival, (B) post-recurrence survival, and (C) overall survival according to surveillance intensity. Abbreviations: LI, low surveillance intensity; HI, high surveillance intensity; LR, low-recurrence risk; HR, high-recurrence risk.

Figure 2

Nomogram predicting the probability of recurrence after radical surgery for colorectal cancer.

Figure 3

Kaplan–Meier analyses of (A) recurrence-free survival, (B) post-recurrence survival, and (C) overall survival according to surveillance intensity and predicted recurrence risk. Abbreviations: LI, low surveillance intensity; HI, high surveillance intensity; LR, low-recurrence risk; HR, high-recurrence risk.