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Proposal of a stage-specific surveillance strategy for colorectal cancer

Date

09 Oct 2016

Session

Poster display

Presenters

Ryosuke Okamura

Citation

Annals of Oncology (2016) 27 (6): 462-468. 10.1093/annonc/mdw385

Authors

R. Okamura1, S. Hasegawa2, K. Hida1, R. Takahashi1, K. Kawada1, K. Sugihara3, Y. Sakai1

Author affiliations

  • 1 Department Of Surgery, Kyoto University Hospital, 606-8507 - Kyoto/JP
  • 2 Department Of Surgery, Fukuoka University Hospital, Fukuoka/JP
  • 3 Department Of Surgery, Tokyo Medical and Dental University, Tokyo/JP
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Resources

Abstract 1164

Background

Current guidelines from ESMO, ASCO, NCCN, and JSCCR recommend intensive postoperative surveillance for colorectal cancer following curative resection, using periodic CEA test, CT scanning, clinic visit, and colonoscopy. However, the optimal frequency of these standard modalities and the duration of surveillance remain debatable.

Methods

We analyzed cohort data from 22 member institutions of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. Patients who underwent curative surgery for stage I to IV colorectal cancer between 1997 and 2006 were included. We assessed the cumulative incidence of recurrence, and estimated the proportion of patients in whom recurrences were detected by the standard surveillance modalities every year after surgery (detection rate; DR).

Results

A total of 18,841 consecutive patients were identified. Overall recurrence rates in stage I, II, III, and IV were 4.2%, 14%, 32%, and 75%, respectively. Surgical resection of recurrence in each stage was performed in 55%, 51%, 43%, and 42% of patients, respectively. More than 95% of recurrences in every stage were first suspected or detected by the standard surveillance modalities. Over 80% of recurrences occurred within the first 3 years in stage II and III, 2 years in stage IV, and 5 years in stage I. Among patients with a 5-year recurrence-free survival, 2.2 % in stage III and 7.0 % in stage IV still experienced recurrence after the 5-year postoperative period. The DR in stage I was consistently low during the surveillance period. The DR in year 1 to 3 of stage II was about twice that of stage I. Furthermore, the DR of stage III was about twice that of stage II. In year 1 to 2 of stage IV, the DR was more than triple that of stage III.

Conclusions

These results suggest that a stage-specific approach to postoperative surveillance may improve the efficiency of detecting recurrences. Further study is needed for a prognostic non-inferiority assessment of this strategy.

Clinical trial identification

Retrospective study

Legal entity responsible for the study

Japanese Study Group for Postoperative Follow-up of Colorectal Cancer

Funding

Japanese Study Group for Postoperative Follow-up of Colorectal Cancer

Disclosure

All authors have declared no conflicts of interest.

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