title: Surveillance for early stages of colon cancer: potentials for optimizing follow-up protocols.
abstract: BACKGROUND
  Although several meta-analyses showed the positive effects of follow-up on the prognosis of colon cancer (CC), international guidelines are not in accordance on appropriate tests and their time frequency to optimize surveillance. Furthermore, stratified strategies based upon risk grading have not been implemented. This approach may be useful to rationalize resources.
  
  
  METHODS
  From 2006, all patients operated for an early stage CC (I, IIA, IIB) according to the 7th edition of the AJCC-2010 classification entered in a prospective surveillance program in accordance to our local guidelines. Patients who underwent surgical resection after 2009 have been excluded to guarantee at least a 5-year follow-up. Classic histopathologic prognostic factors such as grade, T and N status, lymphatic and vascular invasion were assessed. Moreover, tumor budding and tumor-to-stroma proportion were evaluated.
  
  
  RESULTS
  We had complete records of 196 patients. Distribution was as follows: 65 (33.2%) in stage I, 122 (62.2%) in stage IIA, and 9 (4.6%) in stage IIB. Eleven patients (5.6%) had a disease recurrence (local or distant). The median recurrence time was 20 months (range 6-48). Nine patients (82%) had recurrence with 24 months, and 91% were asymptomatic and detected by ultrasound or CT scan. According to the log-rank test, the risk factors with significant effect on the disease-free survival (DFS) were the number of lymph nodes <12 (p = 0.027) and the vascular invasion (p = 0.021), while for the overall (OS), only the vascular invasion was significant (p = 0.043). By the univariate and multivariate analyses, DSF was significantly lower in patients with less than 12 nodes removed, with vascular invasion, and with left of double cancer. OS was negatively affected only by vascular invasion despite the hazard ratios were similar to DSF. Stage IIB was associated with a threefold-increased risk of reduced OS and DSF.
  
  
  CONCLUSIONS
  Stages I and IIA appear to behave similarly and should be considered as true early stages. The detection of fibrosis and budding do not seem to add valuable information for prognosis. In early CC stages, the surveillance program should be maximized within the first two years.
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Elisa
authors: E
authors: Gilardoni
authors: Department of Health Science, Centre of Biostatistics for Clinical Epidemiology, Milano-Bicocca University, Monza, Italy.
authors: Davide Paolo
authors: DP
authors: Bernasconi
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Silvia
authors: S
authors: Poli
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Mattia
authors: M
authors: Garancini
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Margherita
authors: M
authors: Luperto
authors: Unit of Pathology, San Gerardo Hospital, Monza, Italy.
authors: Nicola
authors: N
authors: Zucchini
authors: Unit of Pathology, San Gerardo Hospital, Monza, Italy.
authors: Giorgio
authors: G
authors: Bovo
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Mauro
authors: M
authors: Totis
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
authors: Alvaro
authors: A
authors: Bugatti
authors: Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy. luca.gianotti@unimib.it.|Department of Surgery, San Gerardo Hospital (4° piano A), Via Pergolesi 33, 20052, Monza, Italy. luca.gianotti@unimib.it.
authors: Luca
authors: L
authors: Gianotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate