Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer

doi:10.3390/cancers13081883

. 2021 Apr 14;13(8):1883.

doi: 10.3390/cancers13081883.

Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer

Yuan-Tzu Lan^{1

2}, Shih-Ching Chang^{1

2}, Pei-Ching Lin^{3

4}, Chun-Chi Lin^{1

2}, Hung-Hsin Lin^{1

2}, Sheng-Chieh Huang^{1

2}, Chien-Hsing Lin⁵, Wen-Yi Liang⁶, Wei-Shone Chen^{1

2}, Jeng-Kai Jiang^{1

2}, Shung-Haur Yang^{1

2

7}, Jen-Kou Lin^{1

2}

Affiliations

¹ Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
² Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
³ Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei 11146, Taiwan.
⁴ Department of Health and Welfare, University of Taipei, Taipei 11153, Taiwan.
⁵ Division of Genomic Medicine, National Health Research Institutes, Zhunan 35053, Taiwan.
⁶ Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
⁷ Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan 26058, Taiwan.

PMID: 33919924
PMCID: PMC8070938
DOI: 10.3390/cancers13081883

Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer

Yuan-Tzu Lan et al. Cancers (Basel). 2021.

. 2021 Apr 14;13(8):1883.

doi: 10.3390/cancers13081883.

Authors

Affiliations

¹ Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
² Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
³ Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei 11146, Taiwan.
⁴ Department of Health and Welfare, University of Taipei, Taipei 11153, Taiwan.
⁵ Division of Genomic Medicine, National Health Research Institutes, Zhunan 35053, Taiwan.
⁶ Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
⁷ Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan 26058, Taiwan.

PMID: 33919924
PMCID: PMC8070938
DOI: 10.3390/cancers13081883

Abstract

Background: Few reports have investigated genetic alterations between patients with early and late recurrence following curative surgery for colorectal cancer (CRC).

Methods: A total of 1227 stage I-III CRC patients who underwent curative resection were included retrospectively. Among them, 236 patients had tumor recurrence: 139 had early (<2 years after surgery) and 97 had late (≥2 years after surgery) recurrence. Clinicopathological features and genetic alterations were compared between the two groups.

Results: Compared to those with late recurrence, patients with early recurrence were more likely to have advanced pathological node (N) categories; tumor, node, metastasis (TNM) stages; adjuvant chemotherapy treatment; liver metastases; APC mutations; and worse five-year overall survival rates. Patients with right-sided colon cancer were more likely to develop early recurrence than were those with left-sided colon cancer or rectal cancer. Regarding rectal cancer, patients with early recurrence were more likely to be at advanced pathological N categories and TNM stages than those with late recurrence. Multivariate analysis revealed old age, early recurrence, multiple-site recurrence, and BRAF and NRAS mutations to be independent prognostic factors.

Conclusion: CRC patients with early recurrence have a worse OS rate and more APC mutations than those with late recurrence.

Keywords: colorectal cancer; early recurrence; genetic alteration; late recurrence; prognostic factor.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

**Figure 1**
The oncoprint of genetic mutations for all assessed colorectal cancer (CRC) patients with early and late recurrence.

**Figure 2**
The oncoprint of genetic alterations for patients with early and late recurrence of right-sided and left-sided CRC. The mutation profiles are shown as follows: (A) right-sided colon cancer, (B) left-sided colon cancer, and (C) rectal cancer.

**Figure 3**
Five-year OS rates were significantly lower in CRC patients with early recurrence than in those with late recurrence (38.2% vs. 65.9%, p < 0.001). For right-sided colon cancer, five-year OS rates were significantly lower in CRC patients with early recurrence than in those with late recurrence (29.7% vs. 80.8%, p = 0.004). For left-sided colon cancer, five-year OS rates were not significantly different between CRC patients with early recurrence and those with late recurrence (47.0% vs. 64.9%, p = 0.134). For rectal cancer, five-year OS rates were significantly lower in CRC patients with early recurrence than in those with late recurrence (39.1% vs. 62.0%, p = 0.030). The survival curves are shown as follows: (A) all CRC patients, (B) right-sided colon cancer patients, (C) left-sided colon cancer patients, and (D) rectal cancer patients.

**Figure 4**
Five-year postrecurrence survival rates were not significantly different between CRC patients with early recurrence and those with late recurrence (32.4% vs. 32.8%, p = 0.802). For right-sided colon cancer, five-year postrecurrence rates were not significantly different between patients with early recurrence and patients with late recurrence (24.9% vs. 33.7%, p = 0.366). For left-sided colon cancer, five-year postrecurrence rates were not significantly different between patients with early recurrence and patients with late recurrence (40.6% vs. 29.9%, p = 0.401). For rectal cancer, five-year postrecurrence rates were not significantly different between patients with early recurrence and patients with late recurrence (32.0% vs. 32.4%, p = 0.594). The survival curves are shown as follows: (A) all CRC patients, (B) right-sided colon cancer patients, (C) left-sided colon cancer patients, and (D) rectal cancer patients.

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References

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[1] Keum N., Giovannucci E. Global burden of colorectal cancer: Emerging trends, risk factors and prevention strategies. Nat. Rev. Gastroenterol. Hepatol. 2019;16:713–732. doi: 10.1038/s41575-019-0189-8. - DOI - PubMed

[2] Keum N., Giovannucci E. Global burden of colorectal cancer: Emerging trends, risk factors and prevention strategies. Nat. Rev. Gastroenterol. Hepatol. 2019;16:713–732. doi: 10.1038/s41575-019-0189-8. - DOI - PubMed

[3] Ministry of Health and Welfare, Executive Yuan, Taiwan, Republic of China Taiwan Health and Welfare Report. [(accessed on 3 March 2021)];2019 :19–20. Available online: https://www.mohw.gov.tw/dl-60711-55f2159f-11a6-4c38-8438-08c8367f0d53.html.

[4] Ministry of Health and Welfare, Executive Yuan, Taiwan, Republic of China Taiwan Health and Welfare Report. [(accessed on 3 March 2021)];2019 :19–20. Available online: https://www.mohw.gov.tw/dl-60711-55f2159f-11a6-4c38-8438-08c8367f0d53.html.

[5] Graham R.A., Wang S., Catalano P.J., Haller D.G. Postsurgical surveillance of colon cancer: Preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy. Ann. Surg. 1998;228:59–63. doi: 10.1097/00000658-199807000-00009. - DOI - PMC - PubMed

[6] Graham R.A., Wang S., Catalano P.J., Haller D.G. Postsurgical surveillance of colon cancer: Preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy. Ann. Surg. 1998;228:59–63. doi: 10.1097/00000658-199807000-00009. - DOI - PMC - PubMed

[7] Kjeldsen B.J., Kronborg O., Fenger C., Jorgensen O.D. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br. J. Surg. 1997;84:66–69. - PubMed

[8] Kjeldsen B.J., Kronborg O., Fenger C., Jorgensen O.D. A prospective randomized study of follow-up after radical surgery for colorectal cancer. Br. J. Surg. 1997;84:66–69. - PubMed

[9] Aghili M., Izadi S., Madani H., Mortazavi H. Clinical and pathological evaluation of patients with early and late recurrence of colorectal cancer. Asia Pac. J. Clin. Oncol. 2010;6:35–41. doi: 10.1111/j.1743-7563.2010.01275.x. - DOI - PubMed

[10] Aghili M., Izadi S., Madani H., Mortazavi H. Clinical and pathological evaluation of patients with early and late recurrence of colorectal cancer. Asia Pac. J. Clin. Oncol. 2010;6:35–41. doi: 10.1111/j.1743-7563.2010.01275.x. - DOI - PubMed

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Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer

Affiliations

Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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