Patrick Ely Teloken1, David Ransom2, Ian Faragher3, Ian Jones4, Peter Gibbs5, Cameron Platell6,7. 1. Royal Perth Hospital, Perth, Western Australia, Australia. 2. Oncology Department, St John of God and Royal Perth Hospital, Perth, Western Australia, Australia. 3. Colorectal Surgical Unit, Western Health, Melbourne, Victoria, Australia. 4. Royal Melbourne Hospital, Melbourne, Victoria, Australia. 5. Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 6. Colorectal Surgical Unit, Saint John of God Hospital Subiaco, Perth, Western Australia, Australia. 7. Department of Surgery, University of Western Australia, Perth, Western Australia, Australia.
Abstract
BACKGROUND: Outcomes of patients with stage I colorectal cancer submitted to surgery with curative intent have not been thoroughly explored in contemporary series. METHODS: All patients with colon or rectal adenocarcinoma who underwent resection from the St John of God Hospital (1996-2013) and BioGrid (1991-2013) databases were identified. Patients submitted to local excision, polypectomies or neoadjuvant treatment were excluded. Outcomes included recurrence (combined local and systemic), recurrence-free and overall survival, and survival after recurrence. RESULTS: A total of 1193 patients with stage I disease were included. Median age was 67 (interquartile range 59-75) and median follow-up was 3.2 years (interquartile range 1.4-5.8). Five-year recurrence rate was 7.1% (95% confidence interval (CI) 5.4-9.4%; 5.0% for colon and 11.1% for rectal cancer). Rectal location was an independent predictor of recurrence (hazard ratio (HR) 1.97, 95% CI 1.09-3.55; P = 0.024). Lymphovascular invasion was an independent predictor of recurrence only in patients with rectal cancer (HR 3.0, 95% CI 1.2-7.6; P = 0.018). Five-year recurrence-free survival was 83.2% (95% CI 80.3-85.4%). Age (HR 1.05, 95% CI 1.03-1.07; P < 0.001), elective surgery (HR 0.41, 95% CI 0.21-0.80; P = 0.011) and the American Society of Anesthesiologists (ASA) score (HR 3.08, 95% CI 1.51-6.31; P < 0.001) were independently associated with recurrence-free survival. Median survival after recurrence was 41 months. Resection of recurrence was attempted in 39% of patients. CONCLUSION: Patients with stage I colorectal cancers still have a clinically significant risk of recurrence. Rectal location is independently associated with higher recurrence. Age, elective surgery and ASA are independently associated with recurrence-free survival. A significant proportion of patients with recurrence underwent further resection.
BACKGROUND: Outcomes of patients with stage I colorectal cancer submitted to surgery with curative intent have not been thoroughly explored in contemporary series. METHODS: All patients with colon or rectal adenocarcinoma who underwent resection from the St John of God Hospital (1996-2013) and BioGrid (1991-2013) databases were identified. Patients submitted to local excision, polypectomies or neoadjuvant treatment were excluded. Outcomes included recurrence (combined local and systemic), recurrence-free and overall survival, and survival after recurrence. RESULTS: A total of 1193 patients with stage I disease were included. Median age was 67 (interquartile range 59-75) and median follow-up was 3.2 years (interquartile range 1.4-5.8). Five-year recurrence rate was 7.1% (95% confidence interval (CI) 5.4-9.4%; 5.0% for colon and 11.1% for rectal cancer). Rectal location was an independent predictor of recurrence (hazard ratio (HR) 1.97, 95% CI 1.09-3.55; P = 0.024). Lymphovascular invasion was an independent predictor of recurrence only in patients with rectal cancer (HR 3.0, 95% CI 1.2-7.6; P = 0.018). Five-year recurrence-free survival was 83.2% (95% CI 80.3-85.4%). Age (HR 1.05, 95% CI 1.03-1.07; P < 0.001), elective surgery (HR 0.41, 95% CI 0.21-0.80; P = 0.011) and the American Society of Anesthesiologists (ASA) score (HR 3.08, 95% CI 1.51-6.31; P < 0.001) were independently associated with recurrence-free survival. Median survival after recurrence was 41 months. Resection of recurrence was attempted in 39% of patients. CONCLUSION:Patients with stage I colorectal cancers still have a clinically significant risk of recurrence. Rectal location is independently associated with higher recurrence. Age, elective surgery and ASA are independently associated with recurrence-free survival. A significant proportion of patients with recurrence underwent further resection.
Authors: Lik Hang Lee; Lindy Davis; Lourdes Ylagan; Angela R Omilian; Kristopher Attwood; Canan Firat; Jinru Shia; Philip B Paty; William G Cance Journal: J Natl Cancer Inst Date: 2022-05-09 Impact factor: 11.816
Authors: Jonah Popp; David S Weinberg; Eva Enns; John A Nyman; J Robert Beck; Karen M Kuntz Journal: Value Health Date: 2021-10-13 Impact factor: 5.101