The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on finding reliable prognostic criteria for recurrence.
However, such criteria are not universally accepted, and follow-up is often standardized for all patients, without regard for each individual's level of risk of recurrence. Such a system of follow-up is not cost-effective.
In order to combat this problem, a comparison of operative findings, pathologic features, and follow-up data was made between 1,731 cases of nonrecurring colorectal cancer (821 colon, 910 rectum) and 357 cases of recurrent colorectal cancer (164 colon, 193 rectum).
|Recurrent and nonrecurring colorectal cancers were compared|
|Dis Colon Rectum|
The various factors were all compared after potentially curative surgery had taken place, and the results were analyzed to ascertain what criteria there were for stratifying follow-up according to risk factors.
Single-factor analysis showed that Dukes staging and tumor invasion were significantly associated with recurrence in both rectal and colon carcinoma.
In rectal cancer tumor fixation and grading were also significant factors.
However, recurrence rates, time to recurrence, site of recurrence (locoregional vs. distant), and pattern of metastatic spread were not significantly affected by original tumor site.
In addition, patient age and gender did not significantly affect recurrence, and individual surgeon performance in this series also had no significant effects on tumor recurrence.
With multivariate analysis only, Dukes staging and tumor invasion into adjacent tissues were found to be independent adverse prognostic factors for recurrence.
Members of the Department of Colorectal Surgery, Singapore General Hospital, Singapore, who carried out the study, conclude their report by suggesting that guidelines for follow-up may be based on these factors and follow-up thus stratified according to risk of developing recurrence.