Risk factors for recurrence in stage II/III colorectal cancer patients treated with curative surgery: The impact of postoperative tumor markers and an infiltrative growth pattern

Background and Objectives We evaluated the capacity of clinicopathological factors to predict recurrence in stage II/III colorectal cancer (CRC) patients after curative resection. Methods We retrospectively examined 386 stage II/III CRC patients who underwent curative resections between April 2008 and August 2013. We assessed the predictive power of pre‐ and postoperative tumor marker levels, lymphatic and venous invasion, and infiltrative growth patterns using Cox's proportional hazards model. Results Of 206 stage II and 180 stage III patients, 26 (13%) and 46 (26%) patients, respectively, developed recurrences with median follow‐up times of 51 and 45 months, respectively. Independent risk factors for recurrence were lymphatic invasion (hazard ratio [HR], 5.99; P = 0.0006) and infiltrative growth patterns (HR, 4.02; P = 0.017) in stage II patients; and elevated preoperative carcinoembryonic antigen levels (HR, 3.22; P = 0.004), elevated postoperative carbohydrate antigen 19–9 levels (HR, 5.08; P = 0.005), and infiltrative growth patterns (HR, 3.19; P = 0.037) in stage III patients. Conclusions High‐recurrence risk can be identified in stage II/III CRC patients by assessing perioperative serum tumor marker levels, lymphatic invasion, and infiltrative growth patterns. Intensive follow‐up for patients with these risk factors may help detect recurrences promptly and improve survival. J. Surg. Oncol. 2016;114:368–374. © 2016 Wiley Periodicals, Inc.