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. 2024 Nov 18;5(4):e510.
doi: 10.1097/AS9.0000000000000510. eCollection 2024 Dec.

Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group

Giulia Turri  1 , Luigi Martinelli  2 , Daniela Rega  3 , Nicolò Tamini  4 , Lucia Paiano  5 , Simona Deidda  6 , QuocRiccardo Bao  7 , Laura Lorenzon  8 , Raffaele De Luca  9 , Caterina Foppa  10   11 , Valentina Mari  12 , Giovanni Taffurelli  13 , Arcangelo Picciariello  14 , Patrizia Marsanic  15 , Leandro Siragusa  16 , Francesco Bagolini  17 , Riccardo Nascimbeni  18 , Gianluca Rizzo  19 , Sara Vertaldi  20 , Michele Zuolo  21 , Giorgio Bianchi  22 , Lisa Marie Rorato  23 , Rossella Reddavid  24 , Gaetano Gallo  25   26 , Lorenzo Crepaz  27 , Alberto Di Leo  27 , Mario Trompetto  25 , Enrico Potenza  24 , Mauro Santarelli  23 , Nicola de'Angelis  22 , Francesco Ciarleglio  21 , Marco Milone  20 , Claudio Coco  28 , Guido Alberto Tiberio  18 , Gabriele Anania  17 , Giuseppe S Sica  16 , Andrea Muratore  15 , Donato Francesco Altomare  29 , Isacco Montroni  13 , Maurizio De Luca  12 , Antonino Spinelli  10   11 , Michele Simone  9 , Roberto Persiani  8 , Gaya Spolverato  7 , Angelo Restivo  6 , Nicolò de Manzini  5 , Marco Braga  4 , Paolo Delrio  3 , Giuseppe Verlato  2 , Corrado Pedrazzani  1
Affiliations

Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group

Giulia Turri et al. Ann Surg Open. .

Abstract

Objective: The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery.

Background: Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences are scarce.

Methods: This is a retrospective multicenter cohort study considering patients who underwent surgery at 25 Italian centers between 2010 and 2019, with a minimum follow-up of 24 months. A total of 1883 consecutive adult patients with stage I CC treated with curative surgery were considered, and 1611 fulfilled the inclusion criteria. The primary outcome was the rate of recurrence. Secondary outcomes included survival and risk factors for recurrence.

Results: Eighty patients developed cancer recurrence (5.0%), of which 90% was systemic relapse. The event was more frequent in pT2 (6.0% vs 3.2%, P = 0.013), male patients (6.1% vs 3.6%, P = 0.021), in the presence of lymphovascular invasion (7.2% vs 3.6%, P = 0.01), and in cases of partial resection (11.1% vs 4.6%, P = 0.011). Also, preoperative carcinoembryonic antigen (P = 0.007) and tumor diameter (P < 0.001) were higher in the group who relapsed. Most patients had isolated cancer recurrence (90%). Recurrences peaked between 10 and 18 months after surgery and declined over time. Adjusted Cox regression analysis identified tumor diameter, carcinoembryonic antigen level, lymphovascular invasion, male gender, and less than 12 analyzed lymph nodes as significant risk factors for worse recurrence-free survival.

Conclusions: This study showed that a not negligible rate of stage I CC recur after curative surgery. Most relapses occur at a single site within the first 3 years after surgery. This evidence could be used to optimize postoperative follow-up.

Keywords: colon cancer; follow-up; prognosis; recurrence, stage I.

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Conflict of interest statement

Disclosure: The authors declare that they have nothing to disclose.

Figures

FIGURE 1.
FIGURE 1.
Kaplan–Meier curve showing recurrence-free survival.
FIGURE 2.
FIGURE 2.
Hazard function analysis of cancer recurrence.
See this image and copyright information in PMC

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