Risk factors for postoperative recurrence of ulcerative colitis-associated colorectal cancer

Abstract

Abstract Purpose: Although ulcerative colitis-associated carcinoma (UC-CRC) has been described, there are few reports regarding recurrent cases of UC-CRC. In this study, we investigated the risk factors for recurrence of UC-CRC. Methods: Recurrence-free survival (RFS) was determined for 144 stage 1-3 patients among 210 UC-CRC cases from August 2002 to August 2019. The Kaplan‒Meier method was used to obtain cumulative RFS, and the Cox proportional hazard model was used to extract recurrence risk factors. The interaction term between cancer stage and prognostic factors specific to UC-CRC was evaluated using the Cox model. The Kaplan‒Meier method was applied by cancer stage to the UC-CRC-specific prognostic factors for which interaction effects were indicated. Results: There were 18 recurrence cases involving stages 1 to 3, and the recurrence rate was 12.5%. The cumulative 5-year RFS rate was 87.5%. Multivariable analysis showed that age at surgery (hazard ratio [HR]: 0.95, 95% CI: 0.91-0.99, p=0.02), undifferentiated carcinoma (HR: 4.42, 95% CI: 1.13-17.24, p=0.03), lymph node metastasis (HR: 4.11, 95% CI: 1.08-15.69, p=0.03), and vascular invasion (HR: 8.01, 95% CI: 1.54-41.65, p=0.01) were significant risk factors for recurrence. Patients with stage 3 CRC in the young adult (age <50 years) group had a significantly worse prognosis than those in the adult (age ≥50 years) group (p<0.01). Conclusion: Age at surgery was identified as a risk factor for recurrence of UC-CRC. Young adult patients have a poor prognosis and may require preoperative surveillance endoscopy as well as aggressive postoperative adjuvant chemotherapy in stage 3.