title: Incidence and patterns of late recurrences in rectal cancer patients.
abstract: BACKGROUND
  Long-term recurrences of rectal cancer raised questions about the possible benefit of prolonging the recommended active 5-year clinical and endoscopic surveillance. The aim of this study was to determine for the first time, incidence and patterns of late 10-year recurrence after curative resection of rectal cancer.
  
  
  METHODS
  The study included 1,222 patients with rectal cancer resected for cure between 1985 and 2000 from those registered in two French population-based digestive cancer registries. Information about local recurrences and distant metastases at 10 years was retrospectively and actively collected up to January 1, 2011.
  
  
  RESULTS
  Although the overall 5-year cumulated rate was 39.5 %, the 10-year cumulated rate was 44.1 % (25.6 % for local recurrence and 29.9 % for distant metastases). In multivariate analyses, TNM stage was associated with a higher risk of local recurrence (hazard ratio [HR] stage III vs. stage I = 3.98 [95 % confidence interval, 2.66-5.94]) and of distant metastasis (HR = 3.60 [2.65-4.91]). Preoperative radiotherapy decreased the risk of local recurrence (HR = 0.43 [0.28-0.66]), but not the risk of metastasis. Patients diagnosed between 1995 and 2000 were less prone to develop long-term metastasis than those diagnosed between 1985 and 1989 (HR = 0.66 [0.49-0.88]). Among patients without recurrence 5 years after diagnosis, one patient in 13 developed a recurrence between 5 and 10 years.
  
  
  CONCLUSIONS
  Late recurrences do exist. A personalised surveillance could be extended until 10 years according to the characteristics of primary tumour and the patient.
authors.affiliation: Digestive Cancer Registry of Burgundy, INSERM U866, University Hospital Dijon, University of Burgundy, Dijon Cedex, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cottet
authors.forename: Veronique
authors.initials: V
authors.lastname: Bouvier
authors.forename: Fabien
authors.initials: F
authors.lastname: Rollot
authors.forename: Valérie
authors.initials: V
authors.lastname: Jooste
authors.forename: Laurent
authors.initials: L
authors.lastname: Bedenne
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
authors.forename: Guy
authors.initials: G
authors.lastname: Launoy
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bouvier
mesh_terms: D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011159:Population Surveillance; D011379:Prognosis; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors