eP665 - Predictors and Survival Analysis of Locally Recurrent Colon Cancer at a Single High-volume Institution

Monday, June 3, 2024

2:03 PM – 2:08 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Hans M. Huber, MD

Resident
Mount Sinai Hospital/Memorial Sloan Kettering Cancer Center
Mount Sinai
New York, New York, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

MG

Mithat Gonen, PhD

Attending Biostatistician
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Georgios Karagkounis, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Maria Widmar, MD, MPH, FACS (she/her/hers)

Assistant Attending
Memorial Sloan Kettering Cancer Center
Weill Cornell Medical Center
New York, New York, United States

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This individual has no financial relationships with ineligible companies.
IW

Iris Wei, MD

Surgeon
Memorial Sloan Kettering Cancer Center
New York City, New York, United States

Disclosure information not submitted.
J. Joshua Smith, MD, PhD

Associate Attending
Memorial Sloan Kettering Cancer Center
MSKCC, Weill Cornell Medical College
New York, New York, United States

Disclosure information not submitted.
Garrett M. Nash, MD, MPH

Vice Chair, Department of Surgery
Memorial Sloan Kettering
New York, New York, United States

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Martin Weiser, MD

Attending Surgeon and Professor
Memorial Sloan Kettering Cancer Center
Cornell Medical College
New York, New York, United States

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This individual has no financial relationships with ineligible companies.
Philip B. Paty, FASCRS, FACS

Attending Surgeon, Colorectal Surgery Service
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Julio Garcia-Aguilar, MD, PhD (he/him/his)

Chief Attending
Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Emmanouil Pappou, MD, PhD

Assistant Attending
Memorial Sloan Kettering Cancer Center
new York, New York, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Published literature cites the rate of recurrence for surgically resected colon cancer at 4-7%; however, the outcomes and predictive factors for locally recurrent disease are not well-known. The goal of this study is to ascertain the risk factors and survival associated with local recurrence of non-metastatic colon cancer (LRCC).Methods/Interventions: This is a retrospective observational study at a single high-volume center of all patients undergoing curative-intent resection for non-metastatic colon cancer between January 2006 and December 2018. Primary outcome was the incidence of recurrent disease at the anastomotic site or adjacent mesentery to the previously resected tumor. Secondary outcomes included overall survival within the study period and reoperation for recurrent disease.Results/Outcomes: A total of 2397 patients met inclusion criteria. Median follow-up time was 3.8 years. Of the initial cohort, 69 (2.9%) developed locally recurrent anastomotic or mesenteric disease within the observation period. The median time to recurrence was 12 months and 56 of the 69 (81%) LRCC patients developed recurrence within 3 years. On univariate analysis, local recurrence was associated with poor differentiation (RR 1.50, 95% CI 1.21-1.86, p < 0.0001), pathologic T stage of 3 or higher (RR 6.14, CI 2.37-15.91, p = 0.0001), and pathologic lymph node positivity (RR 1.62, 95% CI 1.22 – 2.14, p = 0.0001). A competing risk analysis was performed to test for the probability of recurrence in the presence of competing risk of death from non-cancer related causes. On this analysis the associations between recurrence and poor differentiation, T stage and lymph node positivity remained statistically significant with p values of 0.0001, 0.0001 and 0.003 respectively. The 3-year risk of local recurrence was 4% while the risk of distant metastasis was 13% according to this analysis.36 (52%) of the patients who would develop local recurrence had initially received adjuvant chemotherapy. Of the recurrent patients, 23 (33%) were treated with chemotherapy only. 14 (20%) patients underwent a second curative intent resection followed by chemotherapy and 15 (22%) were treated with resection only. 11 patients (16%) did not undergo any further oncologic therapy following diagnosis of recurrence, 2 refused any further treatment, and 4 were lost to follow-up.Conclusion/

Discussion: T3 and T4 disease, nodal positivity and poor differentiation may be associated with increased risk of local recurrence. In this series, locally recurrent colon cancer was most likely to develop within 3 years of initial curative-intent resection. It is important to note that our findings on competing risk analysis reached statistical significance only when grouping patients with isolated local recurrence and synchronous local recurrence/metastatic disease. Further study with a larger sample size and an independent validation cohort is necessary to determine the risk factors and potential effective interventions for patients with locally recurrent disease.Figure 1