Annals of Surgery Open (Dec 2024)
Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group
- Giulia Turri, MD,
- Luigi Martinelli, MD,
- Daniela Rega, MD,
- Nicolò Tamini, MD,
- Lucia Paiano, MD,
- Simona Deidda, MD,
- QuocRiccardo Bao, MD,
- Laura Lorenzon, MD, PhD,
- Raffaele De Luca, MD,
- Caterina Foppa, MD, PhD,
- Valentina Mari, MD,
- Giovanni Taffurelli, MD,
- Arcangelo Picciariello, MD, PhD,
- Patrizia Marsanic, MD,
- Leandro Siragusa, MD,
- Francesco Bagolini, MD,
- Riccardo Nascimbeni, MD,
- Gianluca Rizzo, MD, PhD,
- Sara Vertaldi, MD,
- Michele Zuolo, MD,
- Giorgio Bianchi, MD,
- Lisa Marie Rorato, MD,
- Rossella Reddavid, MD, PhD,
- Gaetano Gallo, MD, PhD,
- Lorenzo Crepaz, MD,
- Alberto Di Leo, MD,
- Mario Trompetto, MD,
- Enrico Potenza, MD,
- Mauro Santarelli, MD,
- Nicola de’Angelis, MD, PhD,
- Francesco Ciarleglio, MD,
- Marco Milone, MD, PhD,
- Claudio Coco, MD,
- Guido Alberto Tiberio, MD,
- Gabriele Anania, MD,
- Giuseppe S. Sica, MD, PhD,
- Andrea Muratore, MD,
- Donato Francesco Altomare, MD,
- Isacco Montroni, MD, PhD,
- Maurizio De Luca, MD,
- Antonino Spinelli, MD, PhD,
- Michele Simone, MD,
- Roberto Persiani, MD,
- Gaya Spolverato, MD,
- Angelo Restivo, MD,
- Nicolò de Manzini, MD,
- Marco Braga, MD,
- Paolo Delrio, MD,
- Giuseppe Verlato, MD, PhD,
- Corrado Pedrazzani, MD,
- Adriana Gioia,
- Cristina Vacca,
- Dario Parini,
- Giovanni Tomasicchio,
- Marcello Calabrò,
- Bruno Sensi,
- Filomena Misuriello,
- Carlo Alberto Schena,
- Silvia Picotto
Affiliations
- Giulia Turri, MD
- From the * Chirurgia Generale ed Epatobiliare, Azienda Ospedaliera Universitaria Integrata di Verona, Università degli Studi di Verona, Verona, Italy
- Luigi Martinelli, MD
- † Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Daniela Rega, MD
- ‡ Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione G. Pascale” IRCSS, Naples, Italy
- Nicolò Tamini, MD
- § Chirurgia Generale, IRCCS San Gerardo Monza, Università Milano Bicocca, Milano, Italy
- Lucia Paiano, MD
- ‖ UCO Clinica Chirurgica, Università di Trieste, Trieste, Italy
- Simona Deidda, MD
- ¶ UOC Chirurgia Coloproctologica, AOU Cagliari, Cagliari, Italy
- QuocRiccardo Bao, MD
- # Chirurgia Generale 3, Azienda Ospedaliera Universitaria Integrata di Padova, Padova, Italy
- Laura Lorenzon, MD, PhD
- ** UOC Chirurgia Generale 1, Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Roma, Italy
- Raffaele De Luca, MD
- †† Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Caterina Foppa, MD, PhD
- ‡‡ Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Valentina Mari, MD
- ‖‖ Chirurgia Generale, Ospedale Santa Maria della Misericordia, Rovigo, Italy
- Giovanni Taffurelli, MD
- ¶¶ Chirurgia Colorettale, Ospedale Santa Maria delle Croci, Ravenna, Italy
- Arcangelo Picciariello, MD, PhD
- ## Department of Experimental Medicine, University of Salento, Lecce, Italy
- Patrizia Marsanic, MD
- *** S.C. Chirurgia, Ospedale E. Agnelli, ASL TO 3, Presidio Pinerolo, Italy
- Leandro Siragusa, MD
- ††† Minimally Invasive and Gastrointestinal Surgery Unit, Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
- Francesco Bagolini, MD
- ‡‡‡ Chirurgia 1, Ospedale di Cona, Azienda Ospedaliera Universitaria Integrata di Ferrara, Ferrara, Italy
- Riccardo Nascimbeni, MD
- §§§ Clinica Chirurgica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
- Gianluca Rizzo, MD, PhD
- ‖‖‖ UOC Chirurgia Digestiva e del Colon-Retto - Ospedale Isola Tiberina Gemelli Isola, Roma, Italy
- Sara Vertaldi, MD
- ¶¶¶ Chirurgia Endoscopica, AOUI Federico II Napoli, Napoli, Italy
- Michele Zuolo, MD
- ### APSS, Azienda Provinciale per i Servizi Sanitari, UO di Chirurgia Generale, Ospedale Valli del Noce, Trento, Italy
- Giorgio Bianchi, MD
- **** Unit of Digestive and HPB Surgery, Henri Mordor University Hospital, Paris, France
- Lisa Marie Rorato, MD
- †††† Chirurgia d’Urgenza e PS 3, AOU Città della Salute e della Scienza, Torino, Italy
- Rossella Reddavid, MD, PhD
- ‡‡‡‡ Division of Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
- Gaetano Gallo, MD, PhD
- §§§§ Unità di Chirurgia Colorettale, Clinica Santa Rita, Vercelli, Italy
- Lorenzo Crepaz, MD
- ¶¶¶¶ Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
- Alberto Di Leo, MD
- ¶¶¶¶ Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
- Mario Trompetto, MD
- §§§§ Unità di Chirurgia Colorettale, Clinica Santa Rita, Vercelli, Italy
- Enrico Potenza, MD
- ‡‡‡‡ Division of Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
- Mauro Santarelli, MD
- †††† Chirurgia d’Urgenza e PS 3, AOU Città della Salute e della Scienza, Torino, Italy
- Nicola de’Angelis, MD, PhD
- **** Unit of Digestive and HPB Surgery, Henri Mordor University Hospital, Paris, France
- Francesco Ciarleglio, MD
- ### APSS, Azienda Provinciale per i Servizi Sanitari, UO di Chirurgia Generale, Ospedale Valli del Noce, Trento, Italy
- Marco Milone, MD, PhD
- ¶¶¶ Chirurgia Endoscopica, AOUI Federico II Napoli, Napoli, Italy
- Claudio Coco, MD
- #### Chirurgia Generale 2, Fondazione Policlinico Universitario “A.Gemelli”, IRCCS Roma, Italy
- Guido Alberto Tiberio, MD
- §§§ Clinica Chirurgica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
- Gabriele Anania, MD
- ‡‡‡ Chirurgia 1, Ospedale di Cona, Azienda Ospedaliera Universitaria Integrata di Ferrara, Ferrara, Italy
- Giuseppe S. Sica, MD, PhD
- ††† Minimally Invasive and Gastrointestinal Surgery Unit, Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
- Andrea Muratore, MD
- *** S.C. Chirurgia, Ospedale E. Agnelli, ASL TO 3, Presidio Pinerolo, Italy
- Donato Francesco Altomare, MD
- ***** Dipartimento di Medicina di Precisione e Rigenerativa e Polo Jonico (DiMePRE-J), Università degli Studi Aldo Moro di Bari, Bari, Italy.
- Isacco Montroni, MD, PhD
- ¶¶ Chirurgia Colorettale, Ospedale Santa Maria delle Croci, Ravenna, Italy
- Maurizio De Luca, MD
- ‖‖ Chirurgia Generale, Ospedale Santa Maria della Misericordia, Rovigo, Italy
- Antonino Spinelli, MD, PhD
- ‡‡ Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Michele Simone, MD
- †† Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Roberto Persiani, MD
- ** UOC Chirurgia Generale 1, Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Roma, Italy
- Gaya Spolverato, MD
- # Chirurgia Generale 3, Azienda Ospedaliera Universitaria Integrata di Padova, Padova, Italy
- Angelo Restivo, MD
- ¶ UOC Chirurgia Coloproctologica, AOU Cagliari, Cagliari, Italy
- Nicolò de Manzini, MD
- ‖ UCO Clinica Chirurgica, Università di Trieste, Trieste, Italy
- Marco Braga, MD
- § Chirurgia Generale, IRCCS San Gerardo Monza, Università Milano Bicocca, Milano, Italy
- Paolo Delrio, MD
- ‡ Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione G. Pascale” IRCSS, Naples, Italy
- Giuseppe Verlato, MD, PhD
- † Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Corrado Pedrazzani, MD
- From the * Chirurgia Generale ed Epatobiliare, Azienda Ospedaliera Universitaria Integrata di Verona, Università degli Studi di Verona, Verona, Italy
- Adriana Gioia
- Cristina Vacca
- Dario Parini
- Giovanni Tomasicchio
- Marcello Calabrò
- Bruno Sensi
- Filomena Misuriello
- Carlo Alberto Schena
- Silvia Picotto
- DOI
- https://doi.org/10.1097/AS9.0000000000000510
- Journal volume & issue
-
Vol. 5,
no. 4
p. e510
Abstract
Objective:. The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery. Background:. Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences are scarce. Methods:. This is a retrospective multicenter cohort study considering patients who underwent surgery at 25 Italian centers between 2010 and 2019, with a minimum follow-up of 24 months. A total of 1883 consecutive adult patients with stage I CC treated with curative surgery were considered, and 1611 fulfilled the inclusion criteria. The primary outcome was the rate of recurrence. Secondary outcomes included survival and risk factors for recurrence. Results:. Eighty patients developed cancer recurrence (5.0%), of which 90% was systemic relapse. The event was more frequent in pT2 (6.0% vs 3.2%, P = 0.013), male patients (6.1% vs 3.6%, P = 0.021), in the presence of lymphovascular invasion (7.2% vs 3.6%, P = 0.01), and in cases of partial resection (11.1% vs 4.6%, P = 0.011). Also, preoperative carcinoembryonic antigen (P = 0.007) and tumor diameter (P < 0.001) were higher in the group who relapsed. Most patients had isolated cancer recurrence (90%). Recurrences peaked between 10 and 18 months after surgery and declined over time. Adjusted Cox regression analysis identified tumor diameter, carcinoembryonic antigen level, lymphovascular invasion, male gender, and less than 12 analyzed lymph nodes as significant risk factors for worse recurrence-free survival. Conclusions:. This study showed that a not negligible rate of stage I CC recur after curative surgery. Most relapses occur at a single site within the first 3 years after surgery. This evidence could be used to optimize postoperative follow-up.
