Kim Seijong, Shin Jung Kyong, Park Yoonah, Huh Jung Wook, Kim Hee Cheol, Yun Seong Hyeon, Lee Woo Yong, Cho Yong Beom
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
Cancer Res Treat. 2025 Apr;57(2):507-518. doi: 10.4143/crt.2024.526. Epub 2024 Oct 4.
While colonoscopy is the standard surveillance tool for stage I colorectal cancer according to National Comprehensive Cancer Network guidelines, its effectiveness in detecting recurrence is debated. This study evaluates recurrence risk factors and patterns in stage I colorectal cancer to inform comprehensive surveillance strategies.
A retrospective analysis of 2,248 stage I colorectal cancer patients who underwent radical surgery at Samsung Medical Center (2007-2018) was conducted. Exclusions were based on familial history, prior recurrences, preoperative treatments, and inadequate data. Surveillance included colonoscopy, laboratory tests, and computed tomography (CT) scans.
Stage I colorectal cancer patients showed favorable 5-year disease-free survival (98.3% colon, 94.6% rectum). Among a total of 1,467 colon cancer patients, 26 (1.76%) experienced recurrence. Of the 781 rectal cancer patients, 47 (6.02%) experienced recurrence. Elevated preoperative carcinoembryonic antigen levels and perineural invasion were significant recurrence risk factors in colon cancer, while tumor budding was significant in rectal cancer. Distant metastasis was the main recurrence pattern in colon cancer (92.3%), while rectal cancer showed predominantly local recurrence (50%). Colonoscopy alone detected recurrences in a small fraction of cases (3.7% in colon, 14.9% in rectum).
Although recurrence in stage I colorectal cancer is rare, relying solely on colonoscopy for surveillance may miss distant metastases or locoregional recurrence outside the colorectum. For high-risk patients, we recommend considering regular CT scans alongside colonoscopy. This targeted approach may enable earlier recurrence detection and improve outcomes in this subset while avoiding unnecessary scans for the low-risk majority.
根据美国国立综合癌症网络指南，结肠镜检查是I期结直肠癌的标准监测工具，但其在检测复发方面的有效性存在争议。本研究评估I期结直肠癌的复发危险因素和模式，以为综合监测策略提供依据。
对2007年至2018年在三星医疗中心接受根治性手术的2248例I期结直肠癌患者进行回顾性分析。排除标准基于家族史、既往复发史、术前治疗情况及数据不完整。监测包括结肠镜检查、实验室检查和计算机断层扫描（CT）。
I期结直肠癌患者5年无病生存率良好（结肠癌为98.3%，直肠癌为94.6%）。在总共1467例结肠癌患者中，26例（1.76%）出现复发。在781例直肠癌患者中，47例（6.02%）出现复发。术前癌胚抗原水平升高和神经周围侵犯是结肠癌的重要复发危险因素，而肿瘤芽生在直肠癌中具有重要意义。远处转移是结肠癌的主要复发模式（92.3%），而直肠癌主要表现为局部复发（50%）。仅结肠镜检查在一小部分病例中检测到复发（结肠癌为3.7%，直肠癌为14.9%）。
虽然I期结直肠癌的复发很少见，但仅依靠结肠镜检查进行监测可能会遗漏远处转移或结直肠外的局部区域复发。对于高危患者，我们建议在结肠镜检查的同时考虑定期进行CT扫描。这种有针对性的方法可以在这一亚组中更早地检测到复发并改善预后，同时避免对大多数低风险患者进行不必要的扫描。
