Incidence of Recurrence and Time to Recurrence in Stage I to III Colorectal Cancer

Abstract

ImportanceManagement of colorectal cancer (CRC) has been updated continuously over the past 2 decades. While the combination of these initiatives has had implications for improved survival, the implications for rates of recurrence remain unexplored.ObjectiveTo ascertain the rates of recurrence and describe time to recurrence within 5 years of surgery with curative intent for stages I to III CRC.Design, Setting, and ParticipantsThis cohort study used the Danish Colorectal Cancer Group Database to identify patients with Union for International Cancer Control (UICC) stages I to III CRC who underwent primary surgery between January 1, 2004, and December 31, 2019. They were followed up until recurrence (event), death (competing event), diagnosis of a second cancer (competing event), emigration (censoring event), 5 years postoperatively (censoring event), or January 1, 2023 (censoring event), whichever came first. Recurrence status was ascertained through individual-level linked data from the Danish Cancer Registry, Danish National Patient Registry, and Danish Pathology Registry using a validated algorithm. Data were analyzed from January 1 to August 8, 2023.ExposurePrimary surgery performed during 3 calendar periods (2004-2008, 2009-2013, and 2014-2019) stratified by tumor site (colon or rectum) and UICC stage (I, II, and III).Main Outcomes and MeasuresStage-specific 5-year recurrence reported as the cumulative incidence function (CIF) of recurrence, the association between calendar period of primary surgery and recurrence risk reported as subdistribution hazard ratios (sHRs), and the time from surgery to recurrence.ResultsOf the 34 166 patients with UICC stages I to III CRC (median [IQR] age, 70 [62-77] years); 18 552 males [54.3%]) included in the study, 7027 developed recurrence within 5 years after the primary surgery. For colon cancer, the 5-year CIF of recurrence decreased over the 3 calendar periods from 16.3% to 6.8% for UICC stage I, from 21.9% to 11.6% for UICC stage II, and from 35.3% to 24.6% for UICC stage III colon cancer. For rectal cancer, the 5-year CIF decreased over the 3 periods from 19.9% to 9.5% for stage I, from 25.8% to 18.4% for stage II, and from 38.7% to 28.8% for stage III disease. Patients with stage III disease had a shorter time from surgery to recurrence compared with those with stage I disease (time ratio stage III vs stage I = 0.30; 95% CI, 0.28-0.32). Cancers detected through screening were associated with lower stage-adjusted risks of recurrence (sHR, 0.81; 95% CI, 0.73-0.91) compared with cancers not detected through screening.Conclusions and RelevanceIn this cohort of patients with CRC, the risk of recurrence decreased in patients with stages I to III disease during the study period. Cancer detection by screening was associated with an even lower risk of recurrence. Time to recurrence differed according to UICC stage. Because the risk of recurrence was so low in selected patient groups, future research is warranted to explore risk-stratified surveillance protocols in patients with CRC.

Incidence of late recurrence and second primary cancers 5–10 years after non‐metastatic colorectal cancer

“…International guidelines recommend 5 years of recurrence surveillance after curative intent treatment for CRC 4,5 . However, over the last decades the fraction of CRC patients who are cancer‐free survivors at 5 years has been continuously increasing, 3 which made us raise the question if extended recurrence surveillance beyond 5 years is indicated. To address this, we have investigated the risk of late events including late recurrence, metachronous CRC and second primary cancer after 5‐years of surveillance in a nationwide, contemporary cohort of CRC patients with 10 years of follow‐up.…”

“…Death from CRC is primarily associated with disease recurrence. Despite curative‐intended treatment, every fifth patient with stage I–III disease will develop recurrence with >80% of the recurrences diagnosed within 3 years of primary surgery 2,3 . Correspondingly, international guidelines recommend 5 years of postoperative surveillance to diagnose recurrence and metachronous CRC 4,5 …”

“…Over the last two decades, many countries have introduced different initiatives to reduce CRC recurrence and improve survival 6 . Improvements in recurrence and survival within 5 years following primary treatment has been reported following the implementation of these initiatives 3 . Furthermore, more patients are diagnosed with CRC at an earlier disease stage, 7 and the life expectancy in the general population is increasing 8 .…”

Predicting Treatment Failure in Stage III Colon Cancer Patients After radical surgery: A Retrospective Study

“…Surgery is considered the primary treatment option for stage III colon cancer [14] . However, patients with stage III colon cancer are more prone to postoperative complications and tumor recurrence, which can lead to treatment failure, as they often require more extensive surgery and a range of postoperative treatments [15] . Therefore, there is a need to identify factors associated with treatment failure in stage III colon cancer in order to optimize the treatment of these patients.…”

Relationship of FDG PET/CT imaging features with tumor immune microenvironment and prognosis in colorectal cancer: a retrospective study

“…Radical surgical resection with or without neoadjuvant or adjuvant treatment is a potentially curative treatment for patients with colorectal cancer [ 1 , 2 ]. However, even without distant metastatic lesions, up to 20% of patients with colorectal cancer experience cancer recurrence after curative surgery, necessitating the use of prognostic factors to predict clinical outcomes and aid in selecting optimal treatment strategies [ 3 , 4 ].…”