Cumulative incidence, risk factors and overall survival of disease recurrence after curative resection of stage II-III colorectal cancer: a population-based study.

Real-world data are necessitated to counsel patients about the risk for recurrent disease after curative treatment of colorectal cancer (CRC). This study provided a population-based overview of the epidemiology of recurrent disease in surgically resected stage II/III CRC patients. Patients diagnosed with stage II/III primary CRC between July-December 2015 were selected from the Netherlands Cancer Registry (N=3,762). Cumulative incidence of recurrent disease was estimated, and multivariable competing-risk regression was used to identify risk factors for recurrent disease in primary colon and rectal cancer patients. Moreover, overall survival (OS) after diagnosis of recurrent CRC was estimated. Median clinical follow-up was 58 months (Q1-Q3:22-62). Five-year cumulative incidence of recurrent disease was 21.6% (95%-CI:20.0¬-23.2) and 30.0% (95%-CI:28.3-33.5) for primary colon and rectal cancer patients, respectively. Stage III disease and incomplete resection margin in primary colon cancer patients and extramural vascular invasion in primary rectal cancer patients were strongly (hazard ratio ≥2) associated with recurrent disease. Median OS of patients with distant, locoregional, or the synchronous combination of distant and locoregional recurrent disease was 29, 27, and 13 months, respectively (p<0.001). Patients with distant recurrences limited to liver or lung showed a median OS of 46 and 48 months, respectively. The incidence of recurrent disease was higher in rectal cancer patients than in colon cancer patients, predominantly due to higher rates of distant recurrences. OS after recurrent disease was impaired, but subgroups of patients diagnosed with recurrent disease limited to one site showed statistically significantly longer OS.