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Background <p>Survival after recurrence in colorectal cancer (CRC) is typically evaluated in adjuvant-treated Stage II–III patients, where therapy may select for resistant subclones and biologically modify recurrent tumors. Conversely, the natural history of recurrence in Stage I or chemo-naïve disease remains poorly characterized. We investigated prognostic determinants of cancer-specific survival after recurrence (CS-SAR) in a strictly chemo-naïve cohort.</p> Methods <p>Among 721 patients with pathological Stage I–III CRC who underwent curative resection without perioperative chemotherapy, we identified and analyzed 69 patients who developed recurrence. CS-SAR was analyzed using the Kaplan-Meier method and univariable and multivariable Cox models.</p> Results <p>Initial Stage I disease, oligometastasis, and salvage surgery were favorable prognostic factors, whereas early recurrence was associated with poor CS-SAR. In multivariable analysis, salvage surgery was strongly associated with favorable CS-SAR, whereas the association between oligometastatic status and CS-SAR was attenuated after adjustment of salvage surgery. Initial Stage I disease remained an independent favorable factor.</p> Conclusions <p>Recurrent Stage I CRC may represent a clinically favorable subgroup, characterized by a tendency toward late, oligometastatic recurrence. These recurrence patterns may increase the feasibility of salvage surgery, which was strongly associated with long-term survival. Therefore, careful surveillance and multidisciplinary evaluation for curative-intent salvage strategies upon recurrence should be considered even for early-stage patients.</p>

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Prognostic Factors for Cancer-Specific Survival after Recurrence in Chemo-Naïve Stage I–III Colorectal Cancer

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Tomoyuki Momma,
  • Hirokazu Okayama,
  • Makoto Hasegawa,
  • Yusuke Mori,
  • Yuki Kitabori,
  • Masanori Katagata,
  • Satoshi Fukai,
  • Takahiro Sato,
  • Takuro Matsumoto,
  • Daisuke Ujiie,
  • Shun Chida,
  • Motonobu Saito,
  • Wataru Sakamoto,
  • Koji Kono

摘要

Background

Survival after recurrence in colorectal cancer (CRC) is typically evaluated in adjuvant-treated Stage II–III patients, where therapy may select for resistant subclones and biologically modify recurrent tumors. Conversely, the natural history of recurrence in Stage I or chemo-naïve disease remains poorly characterized. We investigated prognostic determinants of cancer-specific survival after recurrence (CS-SAR) in a strictly chemo-naïve cohort.

Methods

Among 721 patients with pathological Stage I–III CRC who underwent curative resection without perioperative chemotherapy, we identified and analyzed 69 patients who developed recurrence. CS-SAR was analyzed using the Kaplan-Meier method and univariable and multivariable Cox models.

Results

Initial Stage I disease, oligometastasis, and salvage surgery were favorable prognostic factors, whereas early recurrence was associated with poor CS-SAR. In multivariable analysis, salvage surgery was strongly associated with favorable CS-SAR, whereas the association between oligometastatic status and CS-SAR was attenuated after adjustment of salvage surgery. Initial Stage I disease remained an independent favorable factor.

Conclusions

Recurrent Stage I CRC may represent a clinically favorable subgroup, characterized by a tendency toward late, oligometastatic recurrence. These recurrence patterns may increase the feasibility of salvage surgery, which was strongly associated with long-term survival. Therefore, careful surveillance and multidisciplinary evaluation for curative-intent salvage strategies upon recurrence should be considered even for early-stage patients.