Among patients having undergone local endoscopic resection of early invasive (T1) colorectal cancer (CRC), 3.3% were found to have disease recurrence, with a vast majority occurring within 72 months of follow-up, according to the results of a study published in Clinical Gastroenterology and Hepatology.
Investigators conducted a systematic literature search to identify and extract data from studies on the cumulative incidence of local or distant disease recurrence for patients treated with local endoscopic resection of T1 CRC. They calculated pooled estimates with use of mixed-effect logistic regression models.
A total of 71 studies with 5167 endoscopically treated patients with T1 CRC were included in the analysis. The pooled cumulative incidence of any CRC recurrence was 3.3% (209 events; 95% CI, 2.6-4.3; I2=54.9%), with local and distant recurrences occurring at comparable rates (pooled incidences 1.9% and 1.6%, respectively). CRC-related mortality occurred in 42 of 2519 patients (35 studies; pooled incidence 1.7%, 95% CI, 1.2-2.2; I2=0%), and the CRC-related mortality rate among patients with recurrence was 40.8% (42/103 patients). The investigators reported that all but 1 CRC-related death could be attributed to CRC progression (1 patient died as a result of an adverse event associated with salvage surgery).
The majority (95.6%) of recurrences occurred within 72 months of follow-up. The overall pooled incidence of any CRC recurrence was 7.0% for individuals with high-risk T1 CRC (28 studies; 95% CI, 4.9-9.9; I2=48.1%) and 0.7% (36 studies; 95% CI, 0.4-1.2; I2=0%) for individuals with low-risk T1 CRC.
“The odds of survival appear to be quite unfavorable when recurrence is found, with 40.8% of patients eventually dying from it,” noted the researchers. “Of all clinical characteristics analyzed, the risk of recurrence was most significantly influenced by histological risk status (7.0% in high-risk vs 0.7% in low-risk T1 CRCs).”
According to the investigators, the most important limitation of their study involves the quality of the source data. Relevant data on patients, treatment, tumor, and follow-up characteristics could not always be retrieved for their patient group, and a considerable number of studies and patients could not be included in the different subgroup analyses.
“Univariable meta-regression showed that the risk of recurrence was most significantly influenced by histological risk status,” the study authors commented. “These findings suggest that tumor histology is the most important factor to be taken into account in establishing surveillance recommendations for endoscopically treated T1 CRC patients.”
Disclosure: Some of the authors reported affiliations with medical device companies. Please see the original reference for a full list of disclosures.
Dang H, Dekkers N, le Cessie S, et al. Risk and time pattern of recurrences after local endoscopic resection of T1 colorectal cancer: a meta-analysis. Clin Gastroenterol Hepatol. Published online November 30, 2020. doi:10.1016/j.cgh.2020.11.032