Evaluation of appropriate follow-up after curative surgery for patients with colorectal cancer using time to recurrence and survival after recurrence: a retrospective multicenter study
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Tomoki Yamano1, Shinichi Yamauchi2, Kiyoshi Tsukamoto1, Masafumi Noda1, Masayoshi Kobayashi1, Michiko Hamanaka1, Akihito Babaya1, Kei Kimura1, Chihyon Son1, Ayako Imada1, Shino Tanaka1, Masataka Ikeda1, Naohiro Tomita1, Kenichi Sugihara2 and Japanese Study Group for Postoperative Follow-up of Colorectal Cancer
1Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
2Division of Colorectal Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Tomoki Yamano, email: [email protected]
Keywords: colorectal cancer; curative surgery; follow-up; recurrence; survival
Received: March 02, 2018 Accepted: April 12, 2018 Published: May 22, 2018
Background: The follow-up schedule for colorectal cancer patients after curative surgery is inconsistent among the guidelines. Evaluation of time to recurrence (TTR) and survival after recurrence (SAR) may provide evidence for appropriate follow-up.
Methods: We assessed 3039 colon cancer (CC) and 1953 rectal cancer (RC) patients who underwent curative surgery between 2007 and 2008. We evaluated the pre- and post-recurrent clinicopathological factors associated with TTR and SAR in each stage of CC and RC.
Results: The recurrence rates of stages I, II, and III were 1.2%, 13.1%, and 26.3%, respectively, for CC, and 8.4%, 20.0%, and 30.4%, respectively, for RC. In CC patients, high carcinoembryonic antigen (CEA) level and lymphovascular invasion were independent predictors of short TTR. In RC patients, metastatic factors (liver metastasis in stage III) and venous invasion (stage III) were independent predictors of short TTR. The prognostic factors of SAR were age (stage II CC and stage III RC), female gender (stage III RC), high CEA level (stage II RC), histological type (stage III CRC), nodal status (stage III CC), recurrence within 1 year (stage III RC), M1b recurrence (stage II CRC), local recurrence (stage II CC), and no surgical resection after recurrence (stage II and III CRC).
Conclusions: The follow-up schedule for stage I should be different from that for the other stages. We recommend that intensive follow-up is appropriate in stage III CC patients with undifferentiated adenocarcinoma or N2 nodal status, stage II RC patients with high preoperative CEA level, and stage III RC patients.
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