Analysis of risk factors for recurrence and metastasis after radical surgery for stage Ⅲc colorectal cancer

XU Dong; XIE Yi-lin; LU Hui-xin; CHENG Tan-tan; LU Chuan-hui; SU Guo-qiang; LI Fan

doi:10.19538/j.cjps.issn1005-2208.2025.02.13

Abstract：Objective To analyze the risk factors for recurrence and metastasis after radical surgery for stage Ⅲ c colorectal cancer(CRC).Methods A retrospective analysis was conducted on the clinical data of 115 patients with CRC who underwent radical surgery and were pathologically confirmed as TNM stage Ⅲc at the Department of Colorectal Oncology of the First Affiliated Hospital of Xiamen University from July 2016 to June 2022.Based on whether metastasis or recurrence occurred during the 5-year follow-up,the patients were divided into a tumor-free group(66 cases)and the tumor-bearing group(49 cases).Univariate and multivariate analyses were performed on various clinical data between the two groups using the Cox proportional hazards regression model to screen out the risk factors for recurrence and metastasis.Results There were statistically significant differences in CEA,CA19-9,T stage,the number of cancerous nodes,the proportion of metastatic lymph nodes,and the status of root lymph node metastasis between the tumor-free group and the tumor-bearing group(P＜0.05).The results of multivariate analysis showed that CEA＞5 μg/L(HR=2.288,95％CI 1.222-4.286,P=0.01),the proportion of metastatic lymph nodes＞0.412(HR=2.1,95％CI 1.060-4.159,P=0.033),and the positive status of root lymph node metastasis(HR=1.894,95％CI 1.042-3.440,P=0.036)were risk factors for recurrence and metastasis of stage Ⅲ c CRC.In the comparison of cumulative survival curves,for the group with CEA＞5 μg/L,the survival time is shorter than that of the group with CEA≤5 μg/L(x2=9.282,P＜0.002),with a statistically significant difference;for the group with the proportion of metastatic lymph nodes＞0.412,the survival time is shorter than that of the group with the proportion of metastatic lymph nodes ≤0.412(x2=1 1.234,P＜0.001),with a statistically significant difference;for the group with positive root lymph node metastasis,the survival time is shorter than that of the group with negative root lymph node metastasis(x2=9.674,P＜0.001),with a statistically significant difference.The average follow-up time was(42.5±20.1)months,and the 3-year disease-free survival(DFS)time was(29.9±22.0)months.When the root lymph nodes were positive,the 3-year recurrence rate reached 55.6％,and the DFS was 21.2 months.When the proportion of metastatic lymph nodes was＞0.412,the 3-year recurrence rate reached 59.6％,and the DFS was 15.9 months.When patients with CEA＞5 μg/L,positive root lymph nodes,and the proportion of metastatic lymph nodes＞0.412,the 3-year recurrence rate reached 100％,and the DFS was only 13.2 months.Conclusion CEA＞5 μg/L,the proportion of metastatic lymph nodes＞0.412,and positive root lymph nodes are independent risk factors for recurrence and metastasis following radical resection of pathological stage Ⅲc CRC.Patients with these risks should gain great attention and timely intervene.