Table 6.
Time to recurrence rate/freedom from recurrence, recurrence- and disease-free survival in surgical or population-based series of colon or rectal cancer.
| Trial/First Author | Inclusion Dates | Total Number Pts | Number of Patients in Stage I/II/III | Colon/ Rectum |
Proportion Receiving ACT |
Follow-Up Time (Years) | TTR/FFR | RFS/ EFS |
DFS | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Konishi et al., MSKCC early [38] | 1990–2000 | 1320 | 421/520/379 | 100/0 | II: 14% III: 85% |
5 | II: 81% III: 64% |
61% 12+ nodes, created a nomogram | ||
| Konishi et al., MSKCC late [38] | 2007–2014 | 1095 | 286/425/384 | 100/0 | II: 25%, III: 89% |
5 | II: 89%; III: 72% | 85% | 97% 12+ nodes, created a new nomogram because of better results | |
| Collins et al. [35] | 2000–2005 | 134 | 19/90/25 | 100/0 | 46% | 5 | 73% | 48% | Validated the early MSK nomogram, projected | |
| Kazem et al. [37] | 1998–2003 | 138 | 0/10/128 | 100/0 | 30% | 5 | 73% | Validated the early MSK nomogram | ||
| Merkel and Erlangen [138] | 1981–1997 | 305 | 0/305/0 | 100/0 | 0 | 5 | 85% | Well documented quality of the surgery. A small high-risk group identified | ||
| Touchefeu et al. [139] | 2003–2009 | 195 | 0/195/0 | 100/0 | 17% | 3 | 89% | 83% | 93% 12+ nodes, DFS projected | |
| Yamanaka et al. [140] | 2000–2005 | 1487 | 0/1010/564 | 100/0 | 0 | 5 | All 83%, II: 89%, III: 74% | 12 hospitals | ||
| Lavanchy et al. [141] | 2002–2013 | 475 | 94/118/98 | 334/141 | 29% | 5 | 88% | Unclear if RFS or DFS, 165 pts stage IV | ||
| Wanis et al. [142] | 2006–2015 | 1180 | 233/503/444 | 100/0 | 31% | 5 | 84% | 83% | If emergency surgery TTR:71% | |
| Tsikitis and Mayo [143] | 1995–2007 | 1136 | 0/871/265 | 100/0 | II: 20%, III: 72% | 5 | II: 90%, III: 70% |
Mean 17 nodes sampled. Intensive follow-up | ||
| Amri et al., MGH [144] | 2004–2011 | 313 | 0/313/0 | 100/0 | 0 | 5 | 88% | TTR 7% 0–1 risk factor (CEA, high grade, PNI, EMVI, n = 124), 18% if 2–3 risk factors, (n = 50), 25% if all 4 (8 patients), 90% 12+ nodes | ||
| Gertler et al. [145] | 1982–2006 | 492 | 0/492/0 | 100/0 | 0 | 10 | 84% | 85% had RFS 87%, 15% RFS 75%, 83% 12+ nodes. Most patients operated after 1996 | ||
| Kumar et al. [146] | 1999–2008 | 1697 | 0/1697/0 | 100/0 | Low risk: 12%, High risk: 29% |
3 | High-risk group (n = 1286), RFS 79 vs 80% if AC/no AC, Low risk-group (n = 411), 84% RFS if AC, 93% if no AC. No overall data presented | |||
| Tersteeg et al. [147] | 2011–2016 | 407 | 286/121 | 0/100 | NR | 2 | proj 78% | 2% LR, present early results after changed guidelines for RT/CRT | ||
| Ruppert et al., OCUM [148] | 2007–2016 | 545 | 122/125/298 | 0/100 | 5 | 81% | 72% | 41% (n = 174) preop CRT. 5-year DM 19%, 3% LR, 97% had mesorectal plane excision | ||
| Rasanen et al. [149] | 2005–2011 | 481 | 116/129/167 | 0/100 | 42% | 5 | 74% | About half had preop CRT. DM at 5 years in 18% stage O-II, 30% stage III | ||
| Tan et al. [150] | 1999–2007 | 326 | 71/106/149 | 0/100 | 34% | 10 | All: 70% | LR: 8%, DM 22% (42% if ACT, 12% if no ACT), 99% of recurrences within 5 years | ||
| Ishihara et al. [151] | 1997–2006 | 5664 | 2877/2787 | 100/0 | 38% | 5 | All: 83% II: 90% III: 76% |
83% | 22 hospitals, right-sided 84%, left-sided 81% | |
| Chapuis et al. [23] | 1995–2010 | 363 | 0/0/363 | 100/0 | 56% | 5 | All: 65% | CME, competing risk analysis, no difference if ACT or not | ||
| Mroczkowski et al. [55] | 2000–2004 | 15,096 | 5451/9645/8616 | 100/0 | NR | 5 | 90% | 80% 12+ nodes, only 68% adequate follow-up, questioning the recurrence data | ||
| Poulsen et al. [152] | 2009–2010 | 1633 | 524/553/502 | 0/100 | NR | 5 | 89% | LR 4%, 11% systemic recurrences, 54 pts stage IV, 479 (29%) had preop CRT | ||
| Osterman et al. [153] | 2007–2012 | 14,325 | 2,730/6,314/5,201 | 100/0 | II: 12%, III: 61% | 5 | All: 84% II: 89% III: 71% |
Stage II 0–1 risk factor (pT4, <12 nodes, high grade, emergency surgery, vessel/nerve infiltration.) no ACT 90%, 2+ risk factors 78%. Stage III 0 risk factor 78%. 82% 12+ nodes | ||
| Glimelius et al. [16] | 1995–2012 | 28,962 | NR | 0/100 | NR, limited | 5 | 80% | LR down to 4% in both countries from higher values in Norway, DM decreased from 22% to 18% during the time period in both countries | ||
| Uppsala, Sweden (present article) | 2010–2017 | 1212 | 172/381/410 | 806/406 | II: 19%, III: 62% | 5 | 83% | TTR 84% colon, 83% rectum, for further details, see Table 7. |
The same search strategies as used in a previous similar systematic overview [19] evaluating “modern” recurrence risks is colon cancer patients were utilized for this overview. We did not exclude articles that did not present stage-specific results. Totally 25,588 articles were identified, of which the above contained relevant information. In the previous overview, it was reported that patients operated between 1995–2008 and not treated with adjuvant chemotherapy had a DFS (TTR was not reported adequately) of 81% in stage II (n = 2250) and 49% in stage III (n = 312). If adjuvant chemotherapy was provided, DFS was 79% vs 64%. Few of the 37 evaluated studies reported the quality of the care [19]. Abbreviations: TTR/FFR = time to tumour recurrence/freedom from recurrence (100-recurrence rate in % as provided in the articles), RFS/EFS = recurrence-free/event-free survival, DFS = disease-free survival, LR = local recurrence, DM = distant metastasis, RR = recurrence risk, ACT = adjuvant chemotherapy.