Postoperative Follow-up Strategies for the Detection of Recurrence in Patients with Early-stage Colorectal Cancer

早期大腸直腸癌術後追蹤之策略

王立名(Li-Ming Wang) ； 游正府(Jeng-Fu You) ； 黃緒桓(Shu-Huan Huang) ； 賴以立(I-Li Lai) ； 孫麒洹(Ci-Yuan Sun) ； 鄭景中(Ching-Chung Cheng) ； 廖俊凱(Chun-Kai Liao) ； 林岳辰(Yueh-Chen Lin) ； 陳繹中(Yih-Jong Chern) ； 許祐仁(Yu-Jen Hsu) ； 林耕平(Geng-Pin Lin) ； 賴正洲(Cheng-Chou Lai) ； 蔣昇甫(Sum-Fu Chiang) ； 蔡文司(Wen-Sy Tsai) ； 洪欣園(Hsin-Yuan Hung) ； 葉建裕(Chien-Yuh Yeh) ； 謝寶秀(Pao-Shiu Hsieh) ； 江支銘(Jy-Ming Chiang) ； 唐瑞平(Rei-ping Tang) ； 陳進勛(Jinn-Shiun Chen)

《中華民國大腸直腸外科醫學會雜誌》 32卷4期 (2021/12) Pp. 182-190

https://doi.org/10.6312/SCRSTW.202112_32(4).11018

摘要

Background and Objectives. As there are differing opinions regarding the surveillance of patients with early-stage colorectal cancer, we aimed to determine whether the early detection of recurrence provides similar benefits to patients with early-stage (stage I) and late-stage (stage II and III) colorectal cancer. Methods. Patients who underwent curative resection between January 1995 and December 2011 for stage I-III primary colorectal adenocarcinoma were enrolled. Variable values and recurrence patterns in patients with early- and late-stage disease were compared. Results. Between 1995 and 2011, 10,224 patients underwent curative surgery for colon or rectal cancer of pathological stages I, II, or III. Recurrence occurred in 2,568 patients (25.11%). The most common sites of recurrence for early-stage disease were the lungs (36.3%) and liver (32.4%), and for late-stage disease were liver (38.1%) and the lungs (26%). In both early-stage and late-stage disease, recurrence was mostly detected by identifying abnormalities in carcinoembryonic antigen levels; abnormal image was the second most commonly used technique to detect recurrence. Of the 130 patients with early-stage disease who experienced recurrence after curative surgery, 40.7% underwent secondary curative surgery for the recurrent disease, with median survival time of 32 months; however, that of patients who did not undergo surgery was 17 months (p ＜ 0.001). In late-stage patients who experienced recurrence, 33.6% of them underwent secondary curative-intent surgery. Among these, the median survival time was 32 months, and that of those who did not was 13 months (p ＜ 0.001). Conclusions. Patients with late- and early-stage disease who have recurrent cancer derive similar benefits from secondary curative surgery under similar surveillance strategy. However, it may be important to consider factors such as patient stress caused by surveillance and the cost-effectiveness of surveillance.

關鍵字

Early-stage ； Colorectal cancer ； Surveillance ； Recurrence

並列摘要

目的：因為目前對於早期大腸直腸癌術後追蹤仍存在爭議。為了查明大腸直腸癌早期（病理分類第一期）的術後追蹤是否與晚期（病理分類第二、三期）享有相同的益處。方法：挑選本院1995年至2011年轉移性大腸直腸癌術後的患者，分析復發因子。另外也探討患者於復發後接受第二次手術後的存活分析。結果：於1995年至2011年，本院共有10224名患者接受大腸直腸癌手術，並於術後病理分期為第一至三期。其中共有2568名患者發生復發，其中早期大腸癌有130位（5.4%），晚期則有2568位（25.11%）。而早期最常見發生復發的位置為，肺臟（36.3%）以及肝臟（32.4%）。在發現復發的追蹤工具中，大腸直腸癌早期的患者與晚期並無不同，最常見為血液癌胚胎抗原的異常，第二常見則是影像上的異常。而早期大腸直腸癌患者在發生復發後有40.7%進行第二次根治性手術，存活月數中位數為32個月，未進行第二次根治性手術的患者存活月數中位數則為17個月。結論：早期大腸直腸癌術後的病人，進行適當的追蹤，可以享有和晚期病人相同益處。但若對早期大腸直腸癌的病人進行追蹤，於追蹤期間病患承受的壓力以及所花費的成本性價比是需要考量的。

並列關鍵字

早期大腸直腸癌 ； 術後追蹤 ； 復發

參考文獻

Huh, J.W., et al., Early recurrence in patients undergoing curative surgery for colorectal cancer: is it a predictor for poor overall survival? International journal of colorectal disease, 2013. 28(8): p. 1143-1149.

Graham, R.A., et al., Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy. Annals of surgery, 1998. 228(1): p. 59-63.

Tsai, H.L., et al., Predictive factors of early relapse in UICC stage I-III colorectal cancer patients after curative resection. Journal of surgical oncology, 2009. 100(8): p. 736-743.

Fernandez, F.G., et al., Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Annals of surgery, 2004. 240(3): p. 438-47; discussion 447.

National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology, 2021.