Locoregionally Recurrent Colon Cancer: How Far Have We Come? A Population-Based, Retrospective Cohort Study

Hidde Swartjes, Daan W P van Lankveld, Felice N van Erning, Henk M W Verheul, Johannes H W de Wilt, Tijmen Koëter, Pauline A J Vissers, Hidde Swartjes, Daan W P van Lankveld, Felice N van Erning, Henk M W Verheul, Johannes H W de Wilt, Tijmen Koëter, Pauline A J Vissers

Abstract

Background: The reported outcomes of locoregionally recurrent colon cancer (LRCC) are poor, but the literature about LRCC is scarce and aged. Recent population-based studies to provide current insight into LRCC are warranted. This study aimed to provide an overview of the incidence, risk factors, treatment, and overall survival (OS) of patients with LRCC after curative resection of stage I-III primary colon cancer.

Methods: Data on disease recurrence were collected for all patients with a diagnosis of non-metastasized primary colon cancer in the Netherlands during the first 6 months of 2015. Patients who underwent surgical resection (N = 3544) were included in this study. The 3-year cumulative incidence, risk factors, treatment, and OS for patients with LRCC were determined.

Results: The 3-year cumulative incidence of LRCC was 3.8%. Synchronous distant metastases (LRCC-M1) were diagnosed in 62.7% of the patients. The risk factors for LRCC were age of 70 years or older, pT4, pN1-2, and R1-2. Adjuvant chemotherapy was associated with a decreased risk of LRCC for high-risk stage II and stage III patients [hazard ratio (HR), 0.47; 95% confidence interval (CI) 0.31-0.93]. The median OS for the patients with LRCC was 13.1 months (95% CI 9.1-18.3 months). Curative-intent treatment was given to 22.4% of the LRCC patients, and the subsequent 3 years OS was 71% (95% CI 58-87%). The patients treated with palliative treatment and best supportive care showed 3-year OS rates of 15% (95% CI 7.0-31%) and 3.7% (95% CI 1.0-14%), respectively.

Conclusions: The cumulative incidence of LRCC was low, and adjuvant chemotherapy was associated with a decreased risk for LRCC among targeted patients. Curative-intent treatment was given to nearly 1 in 4 LRCC patients, and the OS for this group was high.

Trial registration: ClinicalTrials.gov NCT05475288.

Conflict of interest statement

There are no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Cumulative incidence plot of locoregionally recurrent colon cancer (LRCC) stratified for pathologic stage of primary colon cancer
Fig. 2
Fig. 2
Combined cumulative incidence plot of LRCC-M0 and LRCC-M1. LRCC locoregionally recurrent colon cancer
Fig. 3
Fig. 3
Treatment of LRCC-M0 and LRCC-M1 patients. Blue box: curative-intent treatment. Red box: palliative treatment. Green box: best supportive care. LRCC locoregionally recurrent colon cancer
Fig. 4
Fig. 4
Overall survival plot stratified for LRCC-M0 and LRCC-M1. LRCC locoregionally recurrent colon cancer
Fig. 5
Fig. 5
Overall survival plot stratified for treatment groups (a) complemented by a stacked bar chart displaying the distribution of LRCC-M0 patients, LRCC-M1 patients with synchronous metastases in one organ/site only, and LRCC-M1 patients with synchronous metastases in two or more organs/sites within and across the treatment groups (b). LRCC locoregionally recurrent colon cancer, BSC best supportive care

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–249. doi: 10.3322/caac.21660.
    1. Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, et al. Colorectal cancer. Nat Rev Dis Primers. 2015;1:15065. doi: 10.1038/nrdp.2015.65.
    1. Brouwer NPM, Bos A, Lemmens V, Tanis PJ, Hugen N, et al. An overview of 25 years of incidence, treatment, and outcome of colorectal cancer patients. Int J Cancer. 2018;143:2758–2766. doi: 10.1002/ijc.31785.
    1. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383:1490–1502. doi: 10.1016/S0140-6736(13)61649-9.
    1. Qaderi SM, Andersson TML, Dickman PW, de Wilt JHW, Verhoeven RHA. Temporal improvements noted in life expectancy of patients with colorectal cancer; a Dutch population-based study. J Clin Epidemiol. 2021;137:92–103. doi: 10.1016/j.jclinepi.2021.03.024.
    1. Qaderi SM, Galjart B, Verhoef C, Slooter GD, Koopman M, et al. Disease recurrence after colorectal cancer surgery in the modern era: a population-based study. Int J Colorectal Dis. 2021;36:2399–2410. doi: 10.1007/s00384-021-03914-w.
    1. Read TE, Mutch MG, Chang BW, McNevin MS, Fleshman JW, et al. Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg. 2002;195:33–40. doi: 10.1016/S1072-7515(02)01224-3.
    1. Sjövall A, Granath F, Cedermark B, Glimelius B, Holm T. Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol. 2007;14:432–440. doi: 10.1245/s10434-006-9243-1.
    1. Yun HR, Lee LJ, Park JH, Cho YK, Cho YB, et al. Local recurrence after curative resection in patients with colon and rectal cancers. Int J Colorectal Dis. 2008;23:1081–1087. doi: 10.1007/s00384-008-0530-0.
    1. Elferink MA, Visser O, Wiggers T, Otter R, Tollenaar RA, et al. Prognostic factors for locoregional recurrences in colon cancer. Ann Surg Oncol. 2012;19:2203–2211. doi: 10.1245/s10434-011-2183-4.
    1. Kogler P, Kafka-Ritsch R, Sieb M, Sztankay A, Pratschke J, et al. Therapeutic management and outcome of locoregional recurrence after curative colorectal cancer therapy: a single-center analysis. J Gastrointest Surg. 2014;18:2026–2033. doi: 10.1007/s11605-014-2633-y.
    1. Park JH, Kim MJ, Park SC, Kim MJ, Hong CW, et al. Difference in time to locoregional recurrence between patients with right-sided and left-sided colon cancers. Dis Colon Rectum. 2015;58:831–837. doi: 10.1097/DCR.0000000000000426.
    1. Liska D, Stocchi L, Karagkounis G, Elagili F, Dietz DW, et al. Incidence, patterns, and predictors of locoregional recurrence in colon cancer. Ann Surg Oncol. 2017;24:1093–1099. doi: 10.1245/s10434-016-5643-z.
    1. Chesney TR, Nadler A, Acuna SA, Swallow CJ. Outcomes of resection for locoregionally recurrent colon cancer: a systematic review. Surgery. 2016;160:54–66. doi: 10.1016/j.surg.2016.03.017.
    1. Wisselink DD, Klaver CEL, Hompes R, Bemelman WA, Tanis PJ. Curative-intent surgery for isolated locoregional recurrence of colon cancer: review of the literature and institutional experience. Eur J Surg Oncol. 2020;46:1673–1682. doi: 10.1016/j.ejso.2020.04.021.
    1. Satagopan JM, Ben-Porat L, Berwick M, Robson M, Kutler D, et al. A note on competing risks in survival data analysis. Br J Cancer. 2004;91:1229–1235. doi: 10.1038/sj.bjc.6602102.
    1. Austin PC, Fine JP. Practical recommendations for reporting Fine-Gray model analyses for competing risk data. Stat Med. 2017;36:4391–4400. doi: 10.1002/sim.7501.
    1. Richtlijn Colorectaal carcinoom. 2014.
    1. Richtlijn Colorectaal Carcinoom (CRC), 2019. Retrieved 17 October 2022 at .
    1. Ryuk JP, Choi GS, Park JS, Kim HJ, Park SY, et al. Predictive factors and the prognosis of recurrence of colorectal cancer within 2 years after curative resection. Ann Surg Treat Res. 2014;86:143–151. doi: 10.4174/astr.2014.86.3.143.
    1. Chesney TR, Metz JJ, Nadler A, Quereshy FA, Ashamalla S, et al. Long-term outcomes of resection for locoregional recurrence of colon cancer: a retrospective descriptive cohort study. Eur J Surg Oncol. 2021;47:2390–2397. doi: 10.1016/j.ejso.2021.05.003.
    1. Jarrar A, Sheth R, Tiernan J, Sebikali-Potts A, Liska D, et al. Curative-intent resection for loco-regionally recurrent colon cancer: cleveland clinic experience. Am J Surg. 2020;219:419–423. doi: 10.1016/j.amjsurg.2019.10.023.
    1. Harji DP, Sagar PM, Boyle K, Griffiths B, McArthur DR, et al. Surgical resection of recurrent colonic cancer. Br J Surg. 2013;100:950–958. doi: 10.1002/bjs.9113.
    1. Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, et al. Prognostic factors for survival after salvage surgery for locoregional recurrence of colon cancer. Am J Surg. 2011;201:726–733. doi: 10.1016/j.amjsurg.2010.03.003.
    1. Bowne WB, Lee B, Wong WD, Ben-Porat L, Shia J, et al. Operative salvage for locoregional recurrent colon cancer after curative resection: an analysis of 100 cases. Dis Colon Rectum. 2005;48:897–909. doi: 10.1007/s10350-004-0881-8.
    1. de Neree Tot Babberich MPM, Detering R, Dekker JWT, Elferink MA, Tollenaar R, et al. Achievements in colorectal cancer care during 8 years of auditing in The Netherlands. Eur J Surg Oncol. 2018;44:1361–1370. doi: 10.1016/j.ejso.2018.06.001.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner