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Site and Stage of Colorectal Cancer Influence the Likelihood and Distribution of Disease Recurrence and Postrecurrence Survival: Data From the FACS Randomized Controlled Trial

Pugh, Siân A. BSc, MRCS; Shinkins, Bethany DPhil; Fuller, Alice BSc; Mellor, Jane MSc; Mant, David FRCGP, FRCP, FMedSci; Primrose, John N. MD, FRCS

doi: 10.1097/SLA.0000000000001351

Objectives: To describe patterns of recurrence and postrecurrence survival in a large cohort of accurately staged patients with Dukes’ A-C colorectal cancer.

Background: Recurrence remains a frequent cause of mortality after the treatment of colorectal cancer with curative intent. Understanding the likelihood and site of recurrence informs adjuvant treatment and follow-up.

Methods: Retrospective cohort analysis of data from the FACS (follow-up after colorectal cancer surgery) trial after a median 4.4 years of follow-up; postrecurrence survival was calculated using the Kaplan-Meier method.

Results: Complete data were available for 94% of patients; 189 (17%) patients had experienced recurrence. Incidence of recurrence varied according to the site of the primary (right colon: 51/379, 14%; left colon: 68/421, 16%; rectum: 70/332, 21%; P = 0.023) and initial stage (Dukes’ A: 26/249, 10%; Dukes’ B: 81/537, 15%; Dukes’ C: 82/346, 24%; P < 0.0001). Pulmonary recurrence was most frequently associated with rectal tumors, and multisite/other recurrence with right-sided colonic tumors. Recurrences from lower-stage tumors were more likely to be treatable with curative intent (Dukes’ A: 13/26, 50%; Dukes’ B: 32/81, 40%; Dukes’ C: 20/82, 24%; P = 0.03). Those with rectal tumors benefited most from follow-up (proportion with treatable recurrence: rectum 30/332, 9%; left colon 23/421, 6%; right colon 12/379, 3%; P = 0.003). Both initial stage (log rank P = 0.005) and site of primary (log rank P = 0.01) influenced postrecurrence survival.

Conclusions: The likelihood and site of recurrence, and survival, are influenced by the site and stage of the primary tumor. Those with rectal cancers benefited most from follow-up.

ISRCTN 41458548

*University Surgery, University of Southampton, Southampton, United Kingdom

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom

Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom.

Reprints: Siân A. Pugh, BSc, MRCS, University Surgery, Southampton General Hospital, Mailpoint 816, C Level SAB, Tremona Rd, Southampton, SO16 6YD, UK. E-mail:

Disclosure: The FACS trial was funded and supported by the UK NIHR Health Technology Assessment Programme. The Nuffield Department of Primary Care Health Sciences, University of Oxford, is part of the NIHR School of Primary Care Research. The authors have no conflicts of interest to declare.

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