Risk factors for recurrence in stage II/III colorectal cancer patients treated with curative surgery: The impact of postoperative tumor markers and an infiltrative growth pattern.
OBJECTIVE
We evaluated the capacity of clinicopathological factors to predict recurrence in stage II/III colorectal cancer (CRC) patients after curative resection.


METHODS
We retrospectively examined 386 stage II/III CRC patients who underwent curative resections between April 2008 and August 2013. We assessed the predictive power of pre- and postoperative tumor marker levels, lymphatic and venous invasion, and infiltrative growth patterns using Cox's proportional hazards model.


RESULTS
Of 206 stage II and 180 stage III patients, 26 (13%) and 46 (26%) patients, respectively, developed recurrences with median follow-up times of 51 and 45 months, respectively. Independent risk factors for recurrence were lymphatic invasion (hazard ratio [HR], 5.99; P = 0.0006) and infiltrative growth patterns (HR, 4.02; P = 0.017) in stage II patients; and elevated preoperative carcinoembryonic antigen levels (HR, 3.22; P = 0.004), elevated postoperative carbohydrate antigen 19-9 levels (HR, 5.08; P = 0.005), and infiltrative growth patterns (HR, 3.19; P = 0.037) in stage III patients.


CONCLUSIONS
High-recurrence risk can be identified in stage II/III CRC patients by assessing perioperative serum tumor marker levels, lymphatic invasion, and infiltrative growth patterns. Intensive follow-up for patients with these risk factors may help detect recurrences promptly and improve survival. J. Surg. Oncol. 2016;114:368-374. © 2016 Wiley Periodicals, Inc.
Department of Surgery, Nihonkai General Hospital, Japan.|Department of Advanced Surgical Science and Technology, Tohoku University, Japan.
Kazuaki
K
Tokodai
Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Japan.
Hiroto
H
Narimatsu
Department of Pathology, Nihonkai General Hospital, Japan.
Akiko
A
Nishida
Department of Surgery, Nihonkai General Hospital, Japan.
Kai
K
Takaya
Department of Advanced Surgical Science and Technology, Tohoku University, Japan.
Yasuyuki
Y
Hara
Department of Advanced Surgical Science and Technology, Tohoku University, Japan.
Naoki
N
Kawagishi
Department of Surgery, Nihonkai General Hospital, Japan.
Eiji
E
Hashizume
Department of Advanced Surgical Science and Technology, Tohoku University, Japan.
Noriaki
N
Ohuchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000209:etiology* / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
carbohydrate antigen 19-9; carcinoembryonic antigen; colorectal cancer; infiltrative growth pattern; lymphatic invasion; risk stratification