Incidence and patterns of late recurrences in rectal cancer patients.

BACKGROUND

Long-term recurrences of rectal cancer raised questions about the possible benefit of prolonging the recommended active 5-year clinical and endoscopic surveillance. The aim of this study was to determine for the first time, incidence and patterns of late 10-year recurrence after curative resection of rectal cancer.

METHODS

The study included 1,222 patients with rectal cancer resected for cure between 1985 and 2000 from those registered in two French population-based digestive cancer registries. Information about local recurrences and distant metastases at 10 years was retrospectively and actively collected up to January 1, 2011.

RESULTS

Although the overall 5-year cumulated rate was 39.5 %, the 10-year cumulated rate was 44.1 % (25.6 % for local recurrence and 29.9 % for distant metastases). In multivariate analyses, TNM stage was associated with a higher risk of local recurrence (hazard ratio [HR] stage III vs. stage I = 3.98 [95 % confidence interval, 2.66-5.94]) and of distant metastasis (HR = 3.60 [2.65-4.91]). Preoperative radiotherapy decreased the risk of local recurrence (HR = 0.43 [0.28-0.66]), but not the risk of metastasis. Patients diagnosed between 1995 and 2000 were less prone to develop long-term metastasis than those diagnosed between 1985 and 1989 (HR = 0.66 [0.49-0.88]). Among patients without recurrence 5 years after diagnosis, one patient in 13 developed a recurrence between 5 and 10 years.

CONCLUSIONS

Late recurrences do exist. A personalised surveillance could be extended until 10 years according to the characteristics of primary tumour and the patient.