title: Recurrence in patients with stage I colorectal cancer.
abstract: BACKGROUND
  Outcomes of patients with stage I colorectal cancer submitted to surgery with curative intent have not been thoroughly explored in contemporary series.
  
  
  METHODS
  All patients with colon or rectal adenocarcinoma who underwent resection from the St John of God Hospital (1996-2013) and BioGrid (1991-2013) databases were identified. Patients submitted to local excision, polypectomies or neoadjuvant treatment were excluded. Outcomes included recurrence (combined local and systemic), recurrence-free and overall survival, and survival after recurrence.
  
  
  RESULTS
  A total of 1193 patients with stage I disease were included. Median age was 67 (interquartile range 59-75) and median follow-up was 3.2 years (interquartile range 1.4-5.8). Five-year recurrence rate was 7.1% (95% confidence interval (CI) 5.4-9.4%; 5.0% for colon and 11.1% for rectal cancer). Rectal location was an independent predictor of recurrence (hazard ratio (HR) 1.97, 95% CI 1.09-3.55; P = 0.024). Lymphovascular invasion was an independent predictor of recurrence only in patients with rectal cancer (HR 3.0, 95% CI 1.2-7.6; P = 0.018). Five-year recurrence-free survival was 83.2% (95% CI 80.3-85.4%). Age (HR 1.05, 95% CI 1.03-1.07; P < 0.001), elective surgery (HR 0.41, 95% CI 0.21-0.80; P = 0.011) and the American Society of Anesthesiologists (ASA) score (HR 3.08, 95% CI 1.51-6.31; P < 0.001) were independently associated with recurrence-free survival. Median survival after recurrence was 41 months. Resection of recurrence was attempted in 39% of patients.
  
  
  CONCLUSIONS
  Patients with stage I colorectal cancers still have a clinically significant risk of recurrence. Rectal location is independently associated with higher recurrence. Age, elective surgery and ASA are independently associated with recurrence-free survival. A significant proportion of patients with recurrence underwent further resection.
authors.affiliation: Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Patrick Ely
authors.initials: PE
authors.lastname: Teloken
authors.affiliation: Oncology Department, St John of God and Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ransom
authors.affiliation: Colorectal Surgical Unit, Western Health, Melbourne, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Faragher
authors.affiliation: Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
authors.affiliation: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
authors.affiliation: Colorectal Surgical Unit, Saint John of God Hospital Subiaco, Perth, Western Australia, Australia.|Department of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Platell
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016019:Survival Analysis; D014739:Victoria / Q000453:epidemiology
keywords: colon cancer; rectal cancer; recurrence; surveillance