Intensive Radiographic and Biomarker Surveillance in Stage II and III Colorectal Cancer

Abstract

Objective: The objective of this study was to determine the rate of salvage resections in patients with stage II and III colorectal cancer following intensive surveillance in a comprehensive cancer center. Methods: Patients with stage II and III colorectal cancer with a minimum follow-up of 3 years were included. Carcinoembryonic antigen was obtained every 3 months for 2 years and then every 6 months for years 3–5. CT scans of the chest, abdomen and pelvis were performed every 6 months for 2 years and then yearly for years 3–5. Colonoscopy was performed at year 1 and then every 3 years. Results: One hundred and seventy-seven patients were followed for a median of 60 months; 44 patients were diagnosed with recurrent disease. CT was the first sign of recurrence in 68% of patients. Carcinoembryonic antigen test was normal in 20 patients (45%) at the time of disease recurrence. Twenty-five patients (57%) with recurrent disease underwent curative-intent resection, 12 of whom are still cancer free at a median follow-up of 81 months. Conclusions: In this retrospective study, intensive radiographic screening was associated with a high salvage resection rate, which led to favorable clinical outcomes. Randomized clinical trials are urgently needed to define the optimal duration and schedule of radiographic screening in stage II and III colorectal cancer.

Prognostic Value of Combined Tumor Marker and Controlling Nutritional Status (CONUT) Score in Colorectal Cancer Patients

“…Recent progress in chemotherapy has improved the prognosis of unresectable advanced and recurrent CRC, 2 while early detection of recurrence has been shown to increase survival after curative colectomy for CRC. [3][4] It is therefore important to determine the factors affecting postoperative prognosis in patients with CRC. To this end, serum tumor markers (TMs) are easy to measure and potentially useful for diagnosis, predicting survival rates, and monitoring recurrence following surgery.…”

Combination of C-reactive Protein and Monocyte Count Is a Useful Prognostic Indicator for Patients With Colorectal Cancer

“…Furthermore, multivariate analysis revealed that the combination of CRP and MC was an independent prognostic indicator. Recent progress in chemotherapy has improved the prognosis of unresectable advanced and recurrent CRC (39), while early detection of recurrence has been shown to increase survival after curative colectomy for CRC (40,41). Therefore, the identification of indicators that accurately predict prognosis in CRC patients is critical.…”

Is early surveillance with CT scan necessary in patients with stage II/III colorectal cancer: A retrospective study

“…Previous studies reported the first CT scan ranging from 3 to 12 months after curative resection. However, accumulated incidence of recurrence within 6 months detected by CT scan and the relevant value were not reported .…”

“…Early detection is an important element of salvage treatment, a curative‐intent resection rate of 57% is reported attributed to early detection of metastatic disease . Timely diagnosis was associated with a low burden of disease as reflected by the high percentage of patients with small and solitary recurrence, since size and number of resected metastases have been consistently shown to correlate with long‐term outcome .…”