Prognostic Factors for Cancer-Specific Survival after Recurrence in Chemo-Naïve Stage I-III Colorectal Cancer.

BACKGROUND

Survival after recurrence in colorectal cancer (CRC) is typically evaluated in adjuvant-treated Stage II-III patients, where therapy may select for resistant subclones and biologically modify recurrent tumors. Conversely, the natural history of recurrence in Stage I or chemo-naïve disease remains poorly characterized. We investigated prognostic determinants of cancer-specific survival after recurrence (CS-SAR) in a strictly chemo-naïve cohort.

METHODS

Among 721 patients with pathological Stage I-III CRC who underwent curative resection without perioperative chemotherapy, we identified and analyzed 69 patients who developed recurrence. CS-SAR was analyzed using the Kaplan-Meier method and univariable and multivariable Cox models.

RESULTS

Initial Stage I disease, oligometastasis, and salvage surgery were favorable prognostic factors, whereas early recurrence was associated with poor CS-SAR. In multivariable analysis, salvage surgery was strongly associated with favorable CS-SAR, whereas the association between oligometastatic status and CS-SAR was attenuated after adjustment of salvage surgery. Initial Stage I disease remained an independent favorable factor.

CONCLUSIONS

Recurrent Stage I CRC may represent a clinically favorable subgroup, characterized by a tendency toward late, oligometastatic recurrence. These recurrence patterns may increase the feasibility of salvage surgery, which was strongly associated with long-term survival. Therefore, careful surveillance and multidisciplinary evaluation for curative-intent salvage strategies upon recurrence should be considered even for early-stage patients.