Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2842
Revised: July 18, 2024
Accepted: July 26, 2024
Published online: September 27, 2024
Processing time: 181 Days and 19.4 Hours
Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence. Early recurrence (ER) is related to worse prognosis. To date, few observational studies have reported on the analysis of rectal cancer. Hence, we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.
To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.
Data were retrospectively collected from the institutional database from March 2011 to January 2021. Clinicopathological data at diagnosis, perioperative and postoperative data, and first recurrence were collected and analyzed. ER was defined via receiver operating characteristic curve. Prognostic factors were evaluated using the Kaplan–Meier method and Cox proportional hazards modeling.
We included 131 patients. The optimal cut off value of recurrence-free survival (RFS) to differentiate between ER (n = 55, 41.9%) and late recurrence (LR) (n = 76, 58.1%) was 8 mo. The median post-recurrence survival (PRS) of ER and LR was 1.4 mo and 2.9 mo, respectively (P = 0.008) but PRS was not strongly associated with RFS (R² = 0.04). Risk factors included age ≥ 70 years [hazard ratio (HR) = 1.752, P = 0.047], preoperative concurrent chemoradiotherapy (HR = 3.683, P < 0.001), colostomy creation (HR = 2.221, P = 0.036), and length of stay > 9 d (HR = 0.441, P = 0.006).
RFS of 8 mo was the optimal cut-off value. Although ER was not associated with PRS, it was still related to prognosis; thus, intense surveillance is recommended.
Core tip: Definitions of early recurrence (ER) in resectable rectal cancer are scare, and the guidelines for surveillance of postoperative condition differ. This study provides information on the ER cutoff time and emphasizes the importance of the intense surveillance of postoperative patients, especially during the first year after surgery. Our study also provides the risk factors for early recurrence.