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Recurrence Risk After Up-to-Date Colon Cancer Staging, Surgery, and Pathology

Analysis of the Entire Swedish Population

Osterman, Erik, M.D.; Glimelius, Bengt, M.D., Ph.D.

doi: 10.1097/DCR.0000000000001158
Original Contributions: Colorectal Cancer
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BACKGROUND: Developments in the quality of care of patients with colon cancer have improved surgical outcome and thus the need for adjuvant chemotherapy.

OBJECTIVE: To investigate the recurrence rate in a large population-based cohort after modern staging, surgery, and pathology have been implemented.

DESIGN: This was a retrospective registry study.

SETTINGS: Data from patients included in the Swedish Colorectal Cancer Registry covering 99% of all cases and undergoing surgery for colon cancer stages I to III between 2007 and 2012 were obtained.

PATIENTS: In total, 14,325 patients who did not receive any neoadjuvant treatment, underwent radical surgery, and were alive 30 days after surgery were included.

MAIN OUTCOME MEASURES: Tumor and node classification and National Comprehensive Cancer Network–defined risk factors for recurrence were used to assess overall and stage-specific 5-year recurrence rates.

RESULTS: The median follow-up of nonrecurrent cases was 77 months (range, 47–118 mo). The 5-year recurrence rate was 5% in stage I, 12% in stage II, and 33% in stage III patients. In patients classified as having pT3N0 cancer with no or 1 risk factor, the 5-year recurrence rates were 9% and 11%. Risk factors for shorter time to recurrence were male sex, more advanced pT and pN classification, vascular and perineural invasion, emergency surgery, lack of central ligature, short longitudinal resection margin, postoperative complications, and, in stage III, no adjuvant chemotherapy.

LIMITATIONS: The registry does not contain some recently identified factors of relevance for recurrence rates, and some late recurrences may be missing.

CONCLUSIONS: The recurrence rate is less than that previously observed in historical materials, but current, commonly used risk factors are still useful in evaluating recurrence risks. Stratification by pT and pN classification and the number of risk factors enables the identification of large patient groups characterized by such a low recurrence rate that it is questionable whether adjuvant treatment is motivated. See Video Abstract at

Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden

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Funding/Support: This work was supported by the Swedish Cancer Society, grant No. CAN 2016/447.

Financial Disclosure: None reported.

Corresponding author: Erik Osterman, M.D., Gävle Sjukhus, Kirurgmottagningen, Lasarettsvägen 5, 803 24 Gävle, Sweden. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons