Personalised Oncology Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Australia.
Department of Medical Biology, The University of Melbourne, Parkville, Australia.
Acta Oncol. 2021 Sep;60(9):1106-1113. doi: 10.1080/0284186X.2021.1943519. Epub 2021 Jun 29.
Multiple meta-analyses have demonstrated that routine surveillance following colorectal cancer surgery improves survival outcomes. There is limited data on how recurrence patterns and post-recurrence outcomes vary by individual tumor stage.
Using a multi-site community cohort study, we examined the potential impact of primary tumor stage on the sites of recurrence, management of recurrent disease with curative intent, and post-resection survival. We also explored changes over time.
Of 4257 new colon cancers diagnosed 2001 through 2016, 789 (21.1%) had stage I, 1584 (42.4%) had stage II, and 1360 (36.4%) had stage III colon cancer. For consecutive 5-year periods (2001-2005, 2006-2010, 2011-2016), recurrence rates have declined (23.4 17.1 13.6%, < 0.001), however, the resection rates of metastatic disease (29.3 38.6 35.0%, = 0.21) and post-resection 5-year survival (52.0 51.8 64.2%, = 0.12) have remained steady. Primary tumor stage impacted recurrence rate (3.8 12 28%, < 0.0001 for stage 1, 2, and 3), patterns of recurrence, resection of metastatic disease, (50 42 30%, < 0.0001) and post-resection 5-year survival (92 64 44%, < 0.001).
In this community cohort we defined significant differences in recurrence patterns and post-resection survival by tumor stage, with a diminishing rate of recurrence over time. While recurrence rates were lower with stage I and II disease, the high rate of metastatic disease resection and excellent post-resection outcomes help to justify routine surveillance in these patients.
多项荟萃分析表明，结直肠癌手术后的常规监测可改善生存结果。关于个体肿瘤分期对复发模式和复发后结局的影响，数据有限。
本研究使用多地点社区队列研究，研究了原发肿瘤分期对复发部位、有治愈意图的复发性疾病的治疗以及术后生存的潜在影响。我们还探讨了随时间的变化。
在 2001 年至 2016 年期间诊断的 4257 例新发结肠癌中，789 例（21.1%）为 I 期，1584 例（42.4%）为 II 期，1360 例（36.4%）为 III 期结肠癌。对于连续的 5 年期间（2001-2005 年、2006-2010 年、2011-2016 年），复发率下降（23.4%、17.1%、13.6%，<0.001），但是转移性疾病的切除率（29.3%、38.6%、35.0%，=0.21）和术后 5 年生存率（52.0%、51.8%、64.2%，=0.12）保持稳定。原发肿瘤分期影响复发率（3.8%、12%、28%，1 期、2 期和 3 期<0.0001）、复发模式、转移性疾病的切除（50%、42%、30%，<0.0001）和术后 5 年生存率（92%、64%、44%，<0.001）。
在本社区队列中，我们根据肿瘤分期定义了复发模式和术后生存的显著差异，且随着时间的推移复发率下降。虽然 I 期和 II 期疾病的复发率较低，但转移性疾病切除率高且术后生存结局良好，这有助于证明对这些患者进行常规监测是合理的。
