The Prediction and Prognosis of Early Recurrence in Patients with Colorectal Cancer

Abstract

Background: We discuss the risk factors of the patients relapsed within 6 months, diagnostic methods, treatment methods, and prognosis. Methods: One hundred thirty nine patients had cancer recurrence of consecutive 618 patients who underwent surgical resection for colorectal cancer from 2004 to 2009. Except patients underwent curative resection was not performed, stage IV, transanal local excision, recurrence in other parts of the colon, 90 patients were enrolled in this study. Dividing by recurrence group within six months (Syn group), and recurrence group after 6 months (Met group) and analyzed respectively.. The mean follow-up period of the patients was 33.5 ± 17.1 months (range: 5.00-72.00). Results: All 10 patients with early relapse (Syn group) were stage III and had lymph node metastasis. Stage and lymph node metastasis were statistically significant difference between the two groups (p = 0.039, 0.012). Lymphatic invasion (p = 0.027), and postoperative CEA level (p = 0.015) were a significant difference in early recurrence. Patients who recurred within six months of the 90 patients were 10 cases (11.1%). Among these patients, metastasis alone within the liver and the lungs, each were 3 patients (30.0%), 2 patients (20.0%) respectively and multiple metastases include liver or lung were 2 patients(20.0%). Other local metastases in one patient (10.0%), and bone metastasis in 2 patients (20.0%). But Hepatic recurrence (p = 0.652), peritoneal recurrence (p = 0.295) and the entire region recurrence (p = 0.117), there was no difference between early and late recurrence groups The initial diagnosis of patients with early recurrence was done by CEA/CA19-9 tumor marker rose 50%, and 20% respectively. Definite diagnosis was done by CT (70%), but if we could not find the lung and bone metastases, alternative methods were diagnosed with PET-CT (20%), Bone Scan (10%), respectively. Analysis of treatment methods of 8 patients, the four patients (40%) underwent surgery, and three patients (30%) of the four underwent surgery for the first time as curative treatment was possible, and one patient (10%) of the four received chemotherapy after surgery as curative treatment is not possible. Four patients (40%) were received chemotherapy only. Met group and Syn group's three-year survival rates were 68.6% and 93.1%, respectively. There was a significant difference between the two groups (P <0.035). But, Survival rate of the two groups did not differ after recurrence. (p = 0.250) Patient with recurrence was significant difference in survival according to initial diagnosis stage. (P = 0.049) Conclusion: Patient with early relapse has poor survival than with late relapse. However, survival rate after recurrence is same in two groups and the initial diagnosed stage is the important factor. Therefore, Stage III patients with lymphatic invasion or a high CEA level after surgery should be examined by the abdominal CT scan or examination for bone metastasis within 6 months after surgery.