Proposal for a post-operative surveillance strategy for stage I colorectal cancer patients based on a novel recurrence r
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ORIGINAL ARTICLE
Proposal for a post-operative surveillance strategy for stage I colorectal cancer patients based on a novel recurrence risk stratification: a multicenter retrospective study Tsuyoshi Ozawa 1 & Yojiro Hashiguchi 1 & Soichiro Ishihara 2 & Tamuro Hayama 1 & Takeshi Tsuchiya 1 & Keijiro Nozawa 1 & Shinichi Yamauchi 3 & Kenichi Sugihara 3 & Keiji Matsuda 1 Accepted: 26 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The recurrent risk of stage I colorectal cancer (CRC) is not clear, and the data regarding appropriate post-operative surveillance schedules in stage I CRC are scarce. Objectives We aimed to stratify stage I CRC based on the recurrence risk and evaluate optimal post-operative surveillance durations based on this stratification. Methods We retrospectively analyzed the cases of 6607 stage I CRC patients from 24 institutions. To assess the patients’ clinicopathological factors that impact recurrence-free survival (RFS), we performed univariate and multivariate analyses using Cox proportional hazards models. We divided the patients into classes based on their numbers of factors that were associated with poor RFI in the multivariate analysis. Results Recurrence occurred in 3.9% patients. The multivariate analysis revealed the independent factors for poor RFS: rectal cancer, T2 depth, presence of lymphatic invasion, high level of pre-operative carcinoembryonic antigen, and absence of D2–3 lymphadenectomy. We also divided the patients into three classes based on their numbers of these risk factors; the 3-year and 5year RFS rates were 99.3% and 99.1% in the no-risk patients, 97.4% and 96.5% in the patients with 1–2 risks, and 92.1% and 90.0% in the patients with 3–5 risks, respectively. In the patients with no risk and in the patients with 1–2 risks after 3 years postsurgery, ≤ 1% recurrence occurred. Thus, post-operative surveillance may be omitted in these populations. Conclusions Our new classification properly stratified the recurrence risks of stage I CRC patients, and may help reduce unnecessary post-operative surveillance. Keywords Colorectal cancer . Recurrence-free survival . Cox proportional hazards . Stage I
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03737-1) contains supplementary material, which is available to authorized users. * Tsuyoshi Ozawa [email protected] 1
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 1738606, Japan
2
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3
Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Colorectal cancer (CRC) is one of the frequently diagnosed malignancies and is a leading cause of cancer-associated deaths worldwide [1]. The stage of a malignant CRC tumor is classified according to the tumor-node-metastasis (TNM) classification issued by the American Joint Committee on Cancer (AJCC), and its trea
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