Early Versus Late Recurrence in Rectal Cancer: Does Timing Matter?

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• The definition of early recurrence (ER) in rectal cancer remains unclear.
• The association between ER and post-recurrence survival (PRS) is poorly understood.

Purpose of the Study:

• To determine if time to recurrence (TTR) is associated with PRS in patients with resected rectal cancer.
• To investigate factors influencing PRS in rectal cancer recurrence.

Main Methods:

• Retrospective review of 548 patients with nonmetastatic rectal cancer undergoing curative-intent resection (2003-2018).
• ER defined as recurrence <24 months, late recurrence (LR) as ≥24 months.
• PRS evaluated using Kaplan-Meier and Cox proportional hazards modeling.

Main Results:

• 11.1% of patients experienced recurrence, with a median TTR of 14 months.
• 74% of recurrences were classified as ER; no significant baseline differences between ER and LR groups.
• ER was not associated with worse PRS (P > 0.99); symptomatic recurrence and elevated CEA were linked to worse PRS.

Conclusions:

• Early recurrence (ER) does not negatively impact post-recurrence survival (PRS) in resected rectal cancer.
• Symptomatic recurrences and elevated CEA are associated with worse PRS.
• Metastatic disease limited to the liver or lung may be associated with improved PRS, suggesting a focus on treatable oligometastatic disease.