Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

作     者：Filippo Melli Ilenia Bartolini Matteo Risaliti Rosaria Tucci Maria Novella Ringressi Paolo Muiesan Antonio Taddei Amedeo Amedei 

作者机构：Department of Clinical and Experimental MedicineUniversity of FlorenceAzienda Ospedaliero-Universitaria CareggiFlorence 50134Italy 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第1期

页      面：50-75页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Prognostic factors Recurrence Recurrence patterns Colorectal cancer Longterm follow-up Follow-up programs 

摘      要：BACKGROUND Colorectal cancer is a common tumor with a quite high-related mortality.Despite the used curative treatments,patients will develop cancer recurrence in up to 50%of the cases and/or other primary neoplasms.Although most of the recurrences are discovered within 3 years from the first treatment,a small percentage is found after 5 years.The early detection of recurrence is crucial to allow further therapies improving patients’survival.Several follow-up programs have been developed but the optimal one is far from being established.AIM To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.METHODS Perioperative and long-term data of all consecutive patients surgically treated with curative intent,from January 2006 to June 2009,for colorectal adenocarcinoma,were retrospectively reviewed to find potential prognostic factors associated with:(1)Recurrence incidence;(2)Incidence of an early(within 3 years from surgery)or late recurrence;and(3)Different sites of recurrence.In addition,the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.RESULTS Our study included 234 patients.The median follow-up period has been 119±46.2 mo.The recurrence rate has been 25.6%.Patients with a higher chance to develop recurrence had also the following characteristics:Higher levels of preoperative glycemia and carcinoembryonic antigen,highest anaesthesiologists Score score,occlusion,received a complex operation performed with an open technique,after a longer hospital stay,and showed advanced tumors.The independent prognostic factors for recurrence were the hospital stay,N stage 2,and M stage 1(multivariate analysis).Younger ages were significantly associated with an early recurrence onset.Patients that received intermediate colectomies or segmental resections,having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence,while metastatic diseases at diagnosis were linked with local recurrence.Neoadjuvant treatments showed lung recurrence.Finally,bigger tumors and higher lymph node ratio were associated with peritoneal recurrence(marginally significant).Thirty patients developed a second malignancy during the follow-up time.CONCLUSION Several prognostic factors should be considered for tailored follow-up programs,eventually,beyond 5 years from the first treatment.