Originally published as JCO Early Release 10.1200/JCO.2008.20.7050 on June 29 2009

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Postoperative Surveillance Recommendations for Early Stage Colon Cancer Based on Results From the Clinical Outcomes of Surgical Therapy Trial

From the Division of Colon and Rectal Surgery, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; LDS Hospital, Salt Lake City, UT; Columbia Presbyterian Hospital, New York, NY; Midwest Surgical PA, Wichita, KS; Group Health Cooperative, Seattle, WA; Lahey Clinic, Burlington, MA; and the M. D. Anderson Orlando Cancer Center, Orlando, FL.

Corresponding author: Heidi Nelson, MD, Mayo Clinic, Division of Colon and Rectal Surgery, Gonda 9 South, 200 First St SW, Rochester, MN 55905; e-mail: nelson.heidi{at}mayo.edu.

Purpose Intensive postoperative surveillance is associated with improved survival and recommended for patients with late stage (stage IIB and III) colon cancer. We hypothesized that stage I and IIA colon cancer patients would experience similar benefits.

Patients and Methods Secondary analysis of data from the Clinical Outcomes of Surgical Therapy trial was performed by analyzing results according to TNM stage; early (stage I and IIA, 537 patients) and late (stage IIB and III, 254 patients) stage disease. Five-year recurrence rates were higher in patients with late (35.7%) versus early stage disease (9.5%). Early and late stage salvage rates, recurrence patterns and methods of first detection were compared by ² test.

Results Salvage rates for early- and late-stage disease patients with recurrence were the same (35.9% v 37%; P = .9, respectively). Median survival after second surgery after recurrence was 51.2 and 35.8 months for early- and late-stage patients, respectively. Single sites of first recurrence did not significantly differ between early and late stage, but multiple sites of recurrence occurred less often in early-stage patients (3.6% v 28.6%, for early v late, respectively; P < .001). Methods of first detection of recurrence were not significantly different: carcinoembryonic antigen (29.1% v 37.4%), computed tomography scan (23.6% v 26.4%), chest x-ray (7.3% v 12.1%), and colonoscopy (12.7% v 8.8%), for early versus late stage disease, respectively.

Conclusion Patients with early-stage colon cancer have similar sites of recurrence, and receive similar benefit from postrecurrence therapy as late-stage patients; implementation of surveillance guidelines for early-stage patients is appropriate.

Supported by grants No. CA65157 (to the Mayo Clinic) and CA25224 (to the North Central Cancer Treatment Group).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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