Recurrence more frequent with surgically resected rectal vs. colon cancer lesions
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Key takeaways:
- Researchers observed no differences in recurrence after endoscopic local resection of low- or high-risk CRC lesions.
- Rectal location and tumor size predicted recurrence of surgically resected high-risk lesions.
Patients with high-risk T1 rectal cancer were at greater risk for recurrence after surgical resection than those with colon cancer, although no significant differences were reported after endoscopic local resection, according to research.
“T1 CRC can be selectively treated with endoscopic local resection (LR) or surgical resection (SR) by pathological evaluation of lymph node metastasis (LNM) risk,” Tatsunori Minamide, MD, of the department of gastroenterology and endoscopy at the National Cancer Center Hospital East in Japan, and colleagues wrote in Gastroenterology. “In previous studies, LNM frequency was 10% to 15% in patients with high-risk lesions. Consequently, other risk factors require clarification for refined stratification.”
Using clinical data from 3,789 patients who underwent complete resection of T1 colorectal cancer, Minamide and colleagues assessed the effect of lesion location on recurrence and mortality. They reported 1,044 patients underwent LR (689 for low-risk and 355 for high-risk lesions) and 2,745 patients underwent SR (all for high-risk lesions).
Overall rates of recurrence were 1.2% (95% CI, 0.7-2.1) and 1.8% (95% CI, 1.4-2.4) in LR and SR groups, respectively, while mortality rates were 8.5% (95% CI, 6.9-10.4) and 4.8% (95% CI, 4-5.6).
Outcomes following endoscopic local resection
Among patients who underwent LR for low-risk lesions, researchers observed no significant differences between patients with colon vs. rectal cancer in recurrence (0.5%; 95% CI, 0.1-1.5 vs. 2.1%; 95% CI, 0.3-7.4) and mortality (6.6%; 95% CI, 4.7-8.9 vs. 7.4%; 95% CI, 3-14.6). Five-year cumulative recurrence (0.6%; 95% CI, 0.2-1.7 vs. 3.2%; 95% CI, 0.6-9.9) and recurrence-free survival (92.5%; 95% CI, 89.6-94.6 vs. 88.5%; 95% CI, 78.3-94.1) also did not differ between groups.
Researchers observed similar results among patients who underwent LR for high-risk lesions, with overall recurrence and mortality rates of 1.6% (95% CI, 0.4-4.1) vs. 3.8% (95% CI, 1-9.4) and 12% (95% CI, 8.3-16,8) vs. 12.3% (95% CI, 6.7-20.1). Cumulative recurrence and recurrence-free survival at 5 years was 2.1% (95% CI, 0.7-5) vs. 4.6% (95% CI, 1.5-10.5) and 84% (95% CI, 77.6-88.7) vs. 88.1% (95% CI, 78.9-93.4).
Outcomes following surgical resection
Among patients who underwent SR for high-risk colon and rectal cancer, researchers reported significant differences in overall (1.2%; 95% CI, 0.8-1.8 vs. 3.5%; 95% CI, 2.2-5.1) and distant (1.1%; 95% CI, 0.7-1.7 vs. 3.2%; 95% CI, 2-4.7) recurrence rates. While overall mortality (5.1%; 95% CI, 4.2-6.1 vs. 3.9%; 95% CI, 2.6-5.5) and 5-year recurrence-free survival (94.9%; 95% CI, 93.8-95.8 vs. 94.3%; 95% CI, 92.2-95.8) did not differ between groups, recurrence at 5 years was more frequent among patients in the rectal group (1.3%; 95% CI, 0.8-1.9 vs. 3.7%; 95% CI, 2.5-5.3).
Risk factors for cumulative recurrence in this high-risk lesion group included rectal location (HR = 2.457; 95% CI, 1.387-4.35), tumor size 20 mm or greater (HR = 1.799; 95% CI, 1.005-3.221) and high budding grade (HR = 1.949; 95% CI, 1.04-3.654).
“The overall recurrence rates after SR significantly differed between patients with high-risk T1 colon and rectal cancer, demonstrating the impact of rectal location on recurrence,” Minamide and colleagues wrote. “However, no significant difference was found after LR for high-risk lesions.”
They concluded: “This study revealed that rectal location impacts recurrence after SR of high-risk T1 CRC, suggesting the need for careful surveillance, whereas LR may be an optimal approach for low-risk lesions given its low recurrence rate.”
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