Risk factors for recurrence and metastasis of stage IIIC colorectal cancer: A two-center retrospective cohort study

doi:10.4251/wjgo.121235

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Sep 15, 2026; 18(9): 121235
Published online Sep 15, 2026. doi: 10.4251/wjgo.121235

Risk factors for recurrence and metastasis of stage IIIC colorectal cancer: A two-center retrospective cohort study

Zheng Ruan, Ling-Xin Zhu, Yuan-Yuan Zeng, Chuan-Hui Lu, Guo-Xian Guan, Jun-Wei Wu, Fan Li

Zheng Ruan, Yuan-Yuan Zeng, Chuan-Hui Lu, Jun-Wei Wu, Fan Li, Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China

Ling-Xin Zhu, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China

Chuan-Hui Lu, Jun-Wei Wu, Fan Li, The Graduate School of Fujian Medical University, Fuzhou 350122, Fujian Province, China

Guo-Xian Guan, Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China

Co-first authors: Zheng Ruan and Ling-Xin Zhu.

Co-corresponding authors: Jun-Wei Wu and Fan Li.

Author contributions: Ruan Z drafted the initial version of the paper; Zeng YY was in charge of analyzing data as well as drawing the charts; Ruan Z and Zhu LX have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Zeng YY, Lu CH and Guan GX reviewed and revised the paper and were in charge of collecting data; Wu JW and Li F conceptualized and designed this study and they contributed equally to this study as co-corresponding authors; and all of the authors read and approved the final version of the manuscript to be published.

AI contribution statement: No AI tools (including ChatGPT, Grammarly, DeepL, or any other AI writing/assistance tool) were used in the preparation of this manuscript. No part of the main text (Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion) was AI-generated; all content was fully written by the authors. No AI tool was used for language polishing, translation, data analysis, writing revision, and response to reviewers. No AI tool participated in the study design or interpretation of results.

Supported by National Natural Science Foundation of China, No. 81970462; and Key Medical and Health Project of Xiamen, No. 3502Z20204001.

Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Xiamen University [Approval No. (2025) Scientific Research Ethics Review (016)].

Informed consent statement: Informed Consent was obtained from all individual participants included in the study.

Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: For this study, the data supporting the research findings can be obtained from the corresponding author upon reasonable request.

Corresponding author: Fan Li, MD, Associate Professor, Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Xiamen 361000, Fujian Province, China. lifan14521@163.com

Received: March 21, 2026
Revised: April 28, 2026
Accepted: June 15, 2026
Published online: September 15, 2026
Processing time: 160 Days and 2.1 Hours

Abstract

BACKGROUND

Colorectal cancer (CRC) is a highly common malignancy worldwide. Specifically, stage III CRC patients still have significant risk of recurrence and metastasis after undergoing radical surgery. Currently, prognostic factors for overall stage III CRC are already relatively clear, but research specifically focusing on risk factors for recurrence and metastasis in the stage IIIC subgroup is still limited.

AIM

To investigate the risk factors influencing postoperative recurrence and metastasis in patients with stage IIIC CRC, providing a basis for individualized clinical diagnosis and treatment.

METHODS

A two-center retrospective cohort study was conducted involving 255 patients with pathologically confirmed stage IIIC CRC who underwent curative surgery between July 2019 and June 2022. Clinicopathological data and follow-up outcomes were collected. Multivariate Cox proportional hazards regression models were utilized to identify independent prognostic factors. Disease-free survival (DFS) were estimated using the Kaplan-Meier method and log-rank test.

RESULTS

Multivariate analysis identified preoperative carcinoembryonic antigen (CEA) ≥ 5.0 μg/L (HR = 1.871, 95%CI: 1.267-2.763, P = 0.002), metastatic lymph node ratio (MLR) ≥ 0.51 (HR = 2.132, 95%CI: 1.388-3.275, P = 0.001), and positive root lymph node (PRL; HR = 1.602, 95%CI: 1.072-2.393, P = 0.021) as independent risk factors for diminished DFS. Notably, patients exhibiting all three high-risk factors (CEA ≥ 5.0 μg/L, MLR ≥ 0.51, and PRL) demonstrated a severely reduced median DFS of 16.4 months and a 3-year recurrence rate of 95%.

CONCLUSION

Preoperative CEA ≥ 5.0 μg/L, MLR ≥ 0.51, and PRL are independent risk factors for postoperative recurrence and metastasis in stage IIIC CRC. These clinical determinants are pivotal for identifying high-risk populations and formulating individualized monitoring and treatment strategies.

Keywords: Colorectal cancer; Stage IIIC; Recurrence and metastasis; Metastatic lymph node ratio; Prognostic factors

Core Tip: Patients with stage IIIC colorectal cancer still face a high risk of recurrence and metastasis after undergoing radical surgery. This two-center retrospective study confirmed that preoperative carcinoembryonic antigen ≥ 5.0 μg/L, metastatic lymph node ratio ≥ 0.51, and positive root lymph node metastasis are independent risk factors for recurrence and metastasis. Patients possessing all three risk factors simultaneously constitute a high-risk subgroup. Identifying these key risk factors is conducive to formulating individualized surveillance and treatment strategies.