结直肠癌患者特定阶段监测策略的建议：日本大队列的回顾性分析。

Proposal of a stage-specific surveillance strategy for colorectal cancer patients: A retrospective analysis of Japanese large cohort.

机构信息

Department of Surgery, Kyoto University, Kyoto, Japan; The Japanese Study Group for Postoperative Follow-up of Colorectal Cancer, Japan.

出版信息

Eur J Surg Oncol. 2018 Apr;44(4):449-455. doi: 10.1016/j.ejso.2018.01.080. Epub 2018 Jan 31.

DOI:10.1016/j.ejso.2018.01.080

PMID:29397263

Abstract

BACKGROUND

Frequency and duration of postoperative surveillance for colorectal cancer patients remain debatable, and follow-up data regarding stage I or resected stage IV patients are limited.

METHOD

Cohort data from 22 institutions were retrospectively analyzed; 18,841 patients who underwent curative surgery for stage I to IV cancer were included. The cumulative incidence of recurrence, recurrence rate over surveillance period, and risk of recurrence each year after surgery were assessed.

RESULTS

Recurrence rates in stages I, II, III, and IV were 4.2%, 14%, 32%, and 75%, respectively. Over 80% of recurrences occurred within the first 2 years in stage IV, and 3 years in stages II and III, whereas 86.8% of recurrences occurred in 5 years in stage I. Among patients with 5-year recurrence-free survival, 2.2% in stage III and 7.0% in stage IV still experienced recurrence after the 5-year postoperative period. When the duration is extended to 6 years in stage III and 8 years in stage IV, approximately 1% over the surveillance period would be achieved. In stage I, the risk of recurrence each year after surgery was consistently low, whereas the risks in stages II, III, and IV were high in the early postoperative phase. The risk of recurrence each year in stages III and IV patients were over 2-fold and 6-fold higher than that in stage II, respectively.

CONCLUSIONS

Recurrence patterns were markedly different according to cancer stages. These results suggest that a stage-specific approach to postoperative surveillance may improve the efficiency of detecting recurrences.

摘要

背景

结直肠癌患者术后监测的频率和持续时间仍存在争议，且关于 I 期或可切除 IV 期患者的随访数据有限。

方法

回顾性分析 22 家机构的队列数据；纳入了 18841 例接受 I 期至 IV 期癌症根治性手术的患者。评估了复发的累积发生率、随访期间的复发率以及术后每年的复发风险。

结果

I 期、II 期、III 期和 IV 期的复发率分别为 4.2%、14%、32%和 75%。IV 期 80%以上的复发发生在术后 2 年内，II 期和 III 期发生在术后 3 年内，而 I 期 86.8%的复发发生在术后 5 年内。在 5 年无复发生存的患者中，III 期有 2.2%和 IV 期有 7.0%在术后 5 年后仍有复发。当 III 期的持续时间延长至 6 年，IV 期延长至 8 年时，在监测期内将达到大约 1%的复发率。在 I 期，术后每年的复发风险一直较低，而 II、III 和 IV 期的风险在术后早期较高。III 期和 IV 期患者每年的复发风险分别是 II 期的 2 倍和 6 倍以上。