Hwang Sung Hwan, Shin Seon-Hi, Kim Yun Jin, Lee Jun Ho
Department of Surgery, Hanyang University Guri Hospital, Guri, Korea.
Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.
Ann Surg Treat Res. 2025 Jan;108(1):39-48. doi: 10.4174/astr.2025.108.1.39. Epub 2025 Jan 7.
Patients with stage I colorectal cancer (CRC) rarely experience recurrence after curative resection. Therefore, the risk factors for stage I CRC recurrence are yet to be established. We aimed to identify risk factors for stage I CRC recurrence.
MEDLINE, Embase, and Cochrane Library were searched for articles published between 1990 and 2022. The pooled proportions and hazard ratios (HRs) were calculated. Fixed- or random-effect models were considered based on heterogeneity, using Cochran's Q-statistic and the I-test.
Nine studies involving 19,440 patients were included. Nine analyzed risk factors were identified. T2 stage (pooled HR, 2.070; 95% confidence interval [CI], 1.758-2.438; P < 0.001; I=0.0%), lymphovascular invasion (HR, 1.685; 95% CI, 1.420-1.999; P < 0.001; I = 0.0%), venous invasion (HR, 1.794; 95% CI, 1.515-2.125; P < 0.001; I = 0.0%), CEA level (HR, 1.472; 95% CI, 1.093-1.983; P = 0.011; I = 1.8%) and rectal cancer (HR, 2.981; 95% CI, 2.378-3.735; P < 0.001; I = 0.0%) were risk factors for the recurrence. However, the risk of recurrence in right-sided colon cancer was lower than in left-sided colon cancer. (HR, 0.712; 95% CI, 0.537-0.944; P = 0.018; I = 0.0%). No statistically significant differences were observed in the number of harvested lymph nodes, age, and sex.
T2 stage, lymphovascular invasion, venous invasion, CEA level, rectal cancer, and left-sided colon cancer were risk factors for recurrence in stage I CRC. Intensive monitoring and surveillance are warranted for patients with high-risk features of recurrence.
I期结直肠癌（CRC）患者在根治性切除术后很少出现复发。因此，I期CRC复发的危险因素尚未明确。我们旨在确定I期CRC复发的危险因素。
检索MEDLINE、Embase和Cochrane图书馆中1990年至2022年发表的文章。计算合并比例和风险比（HRs）。根据异质性，使用Cochran's Q统计量和I检验来考虑固定效应或随机效应模型。
纳入了9项研究，涉及19440例患者。确定了9个分析的危险因素。T2期（合并HR，2.070；95%置信区间[CI]，1.758 - 2.438；P < 0.001；I = 0.0%）、淋巴管浸润（HR，1.685；95% CI，1.420 - 1.999；P < 0.001；I = 0.0%）、静脉浸润（HR，1.794；95% CI，1.515 - 2.125；P < 0.001；I = 0.0%）、癌胚抗原（CEA）水平（HR，1.472；95% CI，1.093 - 1.983；P = 0.011；I = 1.8%）和直肠癌（HR，2.981；95% CI，2.378 - 3.735；P < 0.001；I = 0.0%）是复发的危险因素。然而，右侧结肠癌的复发风险低于左侧结肠癌。（HR，0.712；95% CI，0.537 - 0.944；P = 0.018；I = 0.0%）。在获取的淋巴结数量、年龄和性别方面未观察到统计学上的显著差异。
T2期、淋巴管浸润、静脉浸润、CEA水平、直肠癌和左侧结肠癌是I期CRC复发的危险因素。对于具有高复发风险特征的患者，有必要进行强化监测。
