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. 2025 Jan;108(1):39-48.
doi: 10.4174/astr.2025.108.1.39. Epub 2025 Jan 7.

Risk factors for recurrence in stage I colorectal cancer after curative resection: a systematic review and meta-analysis

Sung Hwan Hwang  1 , Seon-Hi Shin  2 , Yun Jin Kim  3   4 , Jun Ho Lee  1   5
Affiliations

Risk factors for recurrence in stage I colorectal cancer after curative resection: a systematic review and meta-analysis

Sung Hwan Hwang et al. Ann Surg Treat Res. 2025 Jan.

Abstract

Purpose: Patients with stage I colorectal cancer (CRC) rarely experience recurrence after curative resection. Therefore, the risk factors for stage I CRC recurrence are yet to be established. We aimed to identify risk factors for stage I CRC recurrence.

Methods: MEDLINE, Embase, and Cochrane Library were searched for articles published between 1990 and 2022. The pooled proportions and hazard ratios (HRs) were calculated. Fixed- or random-effect models were considered based on heterogeneity, using Cochran's Q-statistic and the I2-test.

Results: Nine studies involving 19,440 patients were included. Nine analyzed risk factors were identified. T2 stage (pooled HR, 2.070; 95% confidence interval [CI], 1.758-2.438; P < 0.001; I2=0.0%), lymphovascular invasion (HR, 1.685; 95% CI, 1.420-1.999; P < 0.001; I2 = 0.0%), venous invasion (HR, 1.794; 95% CI, 1.515-2.125; P < 0.001; I2 = 0.0%), CEA level (HR, 1.472; 95% CI, 1.093-1.983; P = 0.011; I2 = 1.8%) and rectal cancer (HR, 2.981; 95% CI, 2.378-3.735; P < 0.001; I2 = 0.0%) were risk factors for the recurrence. However, the risk of recurrence in right-sided colon cancer was lower than in left-sided colon cancer. (HR, 0.712; 95% CI, 0.537-0.944; P = 0.018; I2 = 0.0%). No statistically significant differences were observed in the number of harvested lymph nodes, age, and sex.

Conclusion: T2 stage, lymphovascular invasion, venous invasion, CEA level, rectal cancer, and left-sided colon cancer were risk factors for recurrence in stage I CRC. Intensive monitoring and surveillance are warranted for patients with high-risk features of recurrence.

Keywords: Colorectal neoplasms; Recurrence; Risk factors; Systematic review.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the literature search.
Fig. 2
Fig. 2. Forest plots depicting (A) T-stage, (B) lymphovascular invasion, (C) venous invasion, (D) carcinoembryonic antigen, (E) rectal cancer, and (F) right-sided colon cancer. CI, confidence interval.
Fig. 3
Fig. 3. Funnel plots depicting (A) T-stage, (B) lymphovascular invasion, (C) venous invasion, (D) CEA, (E) rectal cancer, and (F) right-sided colon cancer. CI, confidence interval.
See this image and copyright information in PMC

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