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Proposal for a post-operative surveillance strategy for stage I colorectal cancer patients based on a novel recurrence risk stratification: a multicenter retrospective study

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Abstract

Background

The recurrent risk of stage I colorectal cancer (CRC) is not clear, and the data regarding appropriate post-operative surveillance schedules in stage I CRC are scarce.

Objectives

We aimed to stratify stage I CRC based on the recurrence risk and evaluate optimal post-operative surveillance durations based on this stratification.

Methods

We retrospectively analyzed the cases of 6607 stage I CRC patients from 24 institutions. To assess the patients’ clinicopathological factors that impact recurrence-free survival (RFS), we performed univariate and multivariate analyses using Cox proportional hazards models. We divided the patients into classes based on their numbers of factors that were associated with poor RFI in the multivariate analysis.

Results

Recurrence occurred in 3.9% patients. The multivariate analysis revealed the independent factors for poor RFS: rectal cancer, T2 depth, presence of lymphatic invasion, high level of pre-operative carcinoembryonic antigen, and absence of D2–3 lymphadenectomy. We also divided the patients into three classes based on their numbers of these risk factors; the 3-year and 5-year RFS rates were 99.3% and 99.1% in the no-risk patients, 97.4% and 96.5% in the patients with 1–2 risks, and 92.1% and 90.0% in the patients with 3–5 risks, respectively. In the patients with no risk and in the patients with 1–2 risks after 3 years post-surgery, ≤ 1% recurrence occurred. Thus, post-operative surveillance may be omitted in these populations.

Conclusions

Our new classification properly stratified the recurrence risks of stage I CRC patients, and may help reduce unnecessary post-operative surveillance.

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Acknowledgments

The authors thank the members of the Japanese Study Group for Postoperative Follow-up of CRC: Akio Shiomi (Shizuoka Cancer Center); Heita Ozawa (Tochigi Cancer Center); Hideki Ueno (National Defense Medical College); Hitoshi Kameyama (Niigata University); Ichiro Takemasa (Sapporo Medical University); Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital); Kenichi Hakamada (Hirosaki University); Koji Okabayashi (Keio University); Koji Komori (Aichi Cancer Center Hospital); Masahiko Watanabe (Kitasato University); Masayuki Ohue (Osaka Medical Center for Cancer and Cardiovascular Diseases); Michio Itabashi (Tokyo Women’s Medical University); Naohiro Tomita (Hyogo College of Medicine); Shingo Noura (Osaka International Cancer Institute); Tadahiko Masaki (Kyorin University); Tomomichi Kiyomatsu (National Center for Global Health and Medicine); Tsunekazu Hanai (Fujita Health University); Yasukimi Takii (Niigata Cancer Center Hospital); Yoshiharu Sakai (Kyoto University); Yoshito Akagi (Kurume University); Yukihide Kanemitsu (National Cancer Center Hospital); and Yusuke Kinugasa (Tokyo Medical and Dental University). All the authors have read the manuscript and have approved this submission.

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Authors and Affiliations

  1. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan

    Tsuyoshi Ozawa, Yojiro Hashiguchi, Tamuro Hayama, Takeshi Tsuchiya, Keijiro Nozawa & Keiji Matsuda

  2. Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Soichiro Ishihara

  3. Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Shinichi Yamauchi & Kenichi Sugihara

Authors
  1. Tsuyoshi Ozawa
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  2. Yojiro Hashiguchi
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  4. Tamuro Hayama
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  7. Shinichi Yamauchi
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  8. Kenichi Sugihara
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  9. Keiji Matsuda
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Contributions

Study conception, study design, data analysis, and manuscript drafting were done by T.O.

Data acquisition was done by T. O, T. H, T. T, K.N., and K.M.

Manuscript editing and critical revise were done by Y. H, S. I, T. H, T. T, K. N, S. Y, K.S., and K.M

Corresponding author

Correspondence to Tsuyoshi Ozawa.

Ethics declarations

The study was approved by the Central Institutional Review Board (Tokyo Medical and Dental University) and local ethics committee (Teikyo University ethics committee No. 19-127).

Conflict of interest

The authors declare that they have no conflict of interest.

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Ozawa, T., Hashiguchi, Y., Ishihara, S. et al. Proposal for a post-operative surveillance strategy for stage I colorectal cancer patients based on a novel recurrence risk stratification: a multicenter retrospective study. Int J Colorectal Dis 36, 67–74 (2021). https://doi.org/10.1007/s00384-020-03737-1

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