Department of Gastrointestinal Surgery, Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Acta Oncol. 2023 Dec;62(12):1822-1830. doi: 10.1080/0284186X.2023.2269644. Epub 2023 Nov 25.
Updated knowledge about the rates of recurrence and time to recurrence following curative treatment of colorectal cancer is essential to secure better patient information on prognosis, to serve as a premise in the discussion on adjuvant chemotherapy, and help to properly scale the intensity and length of follow-up.
This is a population-based study investigating aspects on first recurrence after radical treatment of clinical stages I-III of colorectal cancer in Central-Norway during 2001-2015. To reveal any time-trends, data were stratified by the time periods 2001-2005, 2006-2010 and 2011-2015. The cumulative incidence of first recurrence was calculated, treating death of unrelated causes as a competing event. Multivariable Cox analyses were done to calculate cause specific hazard ratios (HR) for risk of recurrence.
At a minimum follow-up of six years, a first recurrence was detected in 1,113/5,556 patients at risk (20.0%). The recurrence rate was reduced from 23.6% in the first time period, through 20.0% in the second, and to 17.2% in the last, < 0.001. The reduction applied to all tumor locations, to pathological disease stages II and III, to both gender, across different tumor differentiations, and to both elective and emergency surgery. In multivariable analyses time period, gender, disease stage, and tumor differentiation were significant determinants for risk of recurrence.
The rate of first recurrence after curative surgery for colorectal cancer was substantially reduced from 2001 to 2015. The reason for the reduction could not be attributed to a single factor only. A combined effect of several incremental improvements, such as an increased use of preoperative radiation for rectal cancers, improved adjuvant chemotherapy for colon cancer, and a reduced proportion of emergency surgery, is suggested.
了解结直肠癌根治性治疗后复发率和复发时间的最新知识对于确保患者更好地了解预后至关重要，是讨论辅助化疗的前提，并有助于适当调整随访的强度和时长。
这是一项基于人群的研究，调查了 2001 年至 2015 年期间挪威中部临床分期 I-III 期结直肠癌根治性治疗后首次复发的情况。为了揭示任何时间趋势，数据按 2001-2005 年、2006-2010 年和 2011-2015 年三个时间段分层。计算首次复发的累积发生率，将无关原因死亡视为竞争事件。采用多变量 Cox 分析计算复发风险的特定原因危险比（HR）。
在至少 6 年的随访中，有 1113/5556 名高危患者（20.0%）发现首次复发。复发率从第一个时间段的 23.6%降低到第二个时间段的 20.0%，最后一个时间段的 17.2%， < 0.001。这种降低适用于所有肿瘤部位、病理疾病分期 II 和 III、男女、不同肿瘤分化程度以及选择性和紧急手术。在多变量分析中，时间段、性别、疾病分期和肿瘤分化是复发风险的重要决定因素。
结直肠癌根治性手术后首次复发率从 2001 年到 2015 年显著降低。这种降低不能归因于单一因素。建议是多种增量改进的综合效果，例如直肠癌术前放疗的增加、结肠癌辅助化疗的改善以及急诊手术比例的降低。
