Objective:This study aimed to investigate transitions of recurrence hazard and peak recurrence time in patients with nonmetastatic CRC using the hazard function.Summary of Background Data:A postoperative surveillance period of 5 years is consistent across major guidelines for patients with nonmetastatic CRC, but surveillance intervals differ. Estimates of instantaneous conditional recurrence rate can help set appropriate intervals.Methods:The study population consisted of 4330 patients with stage I to III CRC who underwent curative resection at the National Cancer Center Hospital between January 2000 and December 2013. Hazard rates of recurrence were calculated using the hazard function.Results:Recurrence rates in patients with stage I, II, and III CRC were 4% (50/1432), 11% (136/1231), and 25% (424/1667), respectively. The hazard curve for stage I was relatively flat and hazard rates were consistently low (<0.0015) for 5 years after surgery. The hazard curve for stage II had a peak hazard rate of 0.0046 at 13.7 months, after which the curve had a long hem to the right. The hazard curve for stage III had an earlier and higher peak than that of stage II (0.0105 at 11.6 months), with a long hem to the right.Conclusions:Changes in recurrence hazard for CRC patients varied considerably by stage. Our findings suggest that short-interval surveillance might be unnecessary for stage I patients for the first 3 years after surgery, whereas short-interval surveillance for the first 3 years should be considered for stage III patients.
misclassification bias in the present study. Thus, disease recurrence among patients with <12 harvested lymph nodes should be analyzed separately.Last, synchronous residual CRC and metachronous (second colorectal primary) CRC detected during surveillance were not analyzed in this study. A previous study reported incidences of 39.0%, 13.1%, and 0.88% for metachronous adenomas, advanced metachronous neoplasia, and metachronous CRC after curative resection for CRC. 5 After risk stratification by male sex, age >65, and left-sided index cancer, the cumulative incidence of advanced metachronous adenomas reached 38.9% at 5 years. 5 Since curative resection was more frequently performed for metachronous diseases than for recurrences, these data should be collected and considered for a comprehensive analysis.Overall, we believe this retrospective study adds value to the effort to develop individualized surveillance schedules for CRC after curative resection. However, the results could be made more accurate and convincing by improving the quality of the methodology and stratifying the patients according to TNM substage, recurrence risk factors, and surgical quality.
BACKGROUND: Various prognostic factors have been reported for bone metastases from different primary tumor sites. However, bone metastases from colorectal cancer are very rare, and the prognostic factors have not been investigated in detail. OBJECTIVE: This study aimed to identify prognostic factors of bone metastases from colorectal cancer. DESIGN: This is a retrospective cohort study using data from a prospectively collected database. SETTINGS: This study was conducted at a single tertiary care cancer center in Japan. PATIENTS: Patients who developed bone metastases from colorectal cancer during the study period among all patients who received initial treatment for colorectal cancer at our hospital between 2005 and 2016 (n = 4538) were included. MAIN OUTCOME MEASURES: Overall survival after diagnosis of bone metastases from colorectal cancer was the main outcome measure. RESULTS: Ninety-four patients developed bone metastases during the study period. The 5-year overall survival rate was 11.0%. Multivariable analysis identified the following independent risk factors associated with poor prognosis: ≥70 years of age at diagnosis of bone metastases (HR, 2.48; 95% CI, 1.24–4.95; p < 0.01), curative surgery not performed as initial treatment (HR, 2.54; 95% CI, 1.24–5.19; p = 0.01), multiple bone metastases (HR, 2.44; 95% CI, 1.30–4.57; p < 0.01), albumin level <3.7 g/dL (HR, 3.80; 95% CI, 1.95–7.39; p < 0.01), CEA ≥30 ng/mL (HR, 1.94; 95% CI, 1.09–3.46; p = 0.02), and less than 3 chemotherapy options remaining at diagnosis of bone metastases (HR, 2.83; 95% CI, 1.51–5.30; p < 0.01). The median survival times for patients with 0-2, 3, and 4-6 risk factors were 25.0, 8.8, and 4.3 months, respectively. LIMITATIONS: The main limitation is the single-center, retrospective design of this study. CONCLUSIONS: Our results may facilitate multidisciplinary decision-making in patients with bone metastases from colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B930. FACTORES PRONÓSTICOS DE LAS METÁSTASIS ÓSEAS DEL CÁNCER COLORRECTAL EN LA ERA DE LA TERAPIA DIRIGIDA ANTECEDENTES: Se han reportado varios factores pronósticos para las metástasis óseas de diferentes sitios de tumores primarios. Sin embargo, las metástasis óseas del cáncer colorrectal son muy raras y los factores pronósticos no se han investigado en detalle. OBJETIVO: Identificar los factores pronósticos de las metástasis óseas del cáncer colorrectal. DISEÑO: Estudio de cohorte retrospectivo utilizando datos de una base de datos recolectada prospectivamente. ENTORNO CLINICO: Un solo centro oncológico de atención terciaria en Japón. PACIENTES: Se seleccionaron pacientes que desarrollaron metástasis óseas de cáncer colorrectal durante el período de estudio entre todos los pacientes que recibieron tratamiento inicial para el cáncer colorrectal en nuestro hospital entre 2005 y 2016 (n = 4538). MEDIDA DE RESULTADO PRINCIPAL: Supervivencia general después del diagnóstico de metástasis óseas por cáncer colorrectal. RESULTADOS: Noventa y cuat...
Background The optimal surveillance period and frequency after curative resection for oesophageal squamous cell carcinoma (OSCC) remain unclear, and current guidelines are mainly based on traditional Kaplan–Meier analyses of cumulative incidence rather than risk analysis. The aim of this study was to determine a suitable follow-up surveillance program following oesophagectomy for OSCC using the hazard function. Methods A total of 1187 patients who underwent curative resection for OSCC between 2000 and 2014 were retrospectively analyzed. The changes in the estimated hazard rates (HRs) of recurrence over time were analyzed according to tumour-node-metastasis stage. Results Four hundred seventy-eight (40.2%) patients experienced recurrence during the follow-up period (median, 116.5 months). The risk of recurrence peaked at 9.2 months after treatment (HR = 0.0219) and then decreased to half the peak value at 24 months post-surgery. The HRs for Stage I and II patients were low (< 0.007) post-treatment. The HR for Stage III patients peaked at 9.9 months (HR = 0.031) and the hazard curve declined to a plateau at 30 months. Furthermore, the HR peaked at 10.8 months (HR = 0.052) in Stage IV patients and then gradually declined from 50 months. Conclusions According to tumour-node-metastasis stage, changes in the HRs of postoperative recurrence in OSCC varied significantly. Intensive surveillance should be undertaken for 3 years in Stage III patients and for 4 years in Stage IV patients, followed by annual screening. For Stage I OSCC patients, a reduction in the surveillance intensity could be taken into consideration.
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