Detection of potentially curable recurrence after colorectal cancer surgery in a real-world population
5 affiliations
- 1Oncology Center Isala, Isala, Zwolle, the Netherlands.
- 2Department of Health Science, Section of Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- 3Department of Epidemiology & Statistics, Isala, Zwolle, the Netherlands.
- 4Department of Gastroenterology and Hepatology, Isala, Zwolle, the Netherlands.
- 5Department of Surgery, Isala, Zwolle, the Netherlands.
Abstract
Introduction: After curative surgery for colorectal cancer (CRC), patients undergo surveillance because of the risk of recurrence; however, only a subset develops recurrence amenable to further curative-intent treatment. The primary aim of follow‑up is to identify patients with potentially curable recurrence. Materials and methods: A retrospective analysis was performed of stage I–IV CRC patients who underwent curative-intent treatment and entered postoperative surveillance at Isala between 2014 and 2018. Follow‑up was conducted according to Dutch guideline‑based protocols for 60 months. Patients were categorized as having no recurrence, a potentially curable recurrence, or a non-curable recurrence. Prognostic factors at start of follow-up for potentially curable recurrence were assessed using competing‑risk Cox regression, with non-curable recurrence and death as competing events. For patients with recurrence, mode and time of detection were evaluated. Results: During a median follow-up of 60 months, recurrence occurred in 22.4% of 1118 patients. The cumulative incidence function (CIF) of a potentially curable recurrence was 8.0%. Independent variables associated with a potentially curable recurrence were age HR 0.97 (95% CI 0.96–0.99), minor postoperative complications HR 1.78 (95% CI 1.16–2.72), stage III CRC HR2.76 (95% CI 1.19–6.38) and stage IV CRC HR 11.02 (95% CI 4.44–27.37). Among patients with a recurrence, CEA ≥ 5 ng/mL was present in 63% of all recurrences, but less often in the potentially curable group (57% vs. 69%, p = 0.057). Median time to detection of a potentially curable recurrence was 16 months (IQR 20). The overall number needed to follow-up (NNFU) to detect one potentially curable recurrence was 9.8, with the lowest NNFU observed in stage IV CRC (2.3) and in rectal cancer (6.9). Conclusion: Standard follow-up enabled the detection of potentially curable recurrence in 8% of CRC patients. The substantial variation in NNFU across subgroups and the limited sensitivity of CEA underscore the need for more personalized, risk‑adapted surveillance strategies.
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BibTeX
@article{schoenaker2026detection,
title = {{Detection of potentially curable recurrence after colorectal cancer surgery in a real-world population}},
author = {Ivonne J H Schoenaker and Richard M Brohet and Evelyn J Finnema and Dominique C Damminga and Helle-Brit Fiebrich and Wouter H de Vos Tot Nederveen Cappel and Henderik L van Westreenen},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361933},
url = {https://doi.org/10.1371/journal.pone.0361933},
note = {CC BY},
}
RIS
TY - JOUR
TI - Detection of potentially curable recurrence after colorectal cancer surgery in a real-world population
AU - Ivonne J H Schoenaker
AU - Richard M Brohet
AU - Evelyn J Finnema
AU - Dominique C Damminga
AU - Helle-Brit Fiebrich
AU - Wouter H de Vos Tot Nederveen Cappel
AU - Henderik L van Westreenen
PY - 2026
DA - 2026/10/30
JO - PLOS One
DO - 10.1371/journal.pone.0361933
UR - https://doi.org/10.1371/journal.pone.0361933
AB - Introduction: After curative surgery for colorectal cancer (CRC), patients undergo surveillance because of the risk of recurrence; however, only a subset develops recurrence amenable to further curative-intent treatment. The primary aim of follow‑up is to identify patients with potentially curable recurrence. Materials and methods: A retrospective analysis was performed of stage I–IV CRC patients who underwent curative-intent treatment and entered postoperative surveillance at Isala between 2014 and 2018. Follow‑up was conducted according to Dutch guideline‑based protocols for 60 months. Patients were categorized as having no recurrence, a potentially curable recurrence, or a non-curable recurrence. Prognostic factors at start of follow-up for potentially curable recurrence were assessed using competing‑risk Cox regression, with non-curable recurrence and death as competing events. For patients with recurrence, mode and time of detection were evaluated. Results: During a median follow-up of 60 months, recurrence occurred in 22.4% of 1118 patients. The cumulative incidence function (CIF) of a potentially curable recurrence was 8.0%. Independent variables associated with a potentially curable recurrence were age HR 0.97 (95% CI 0.96–0.99), minor postoperative complications HR 1.78 (95% CI 1.16–2.72), stage III CRC HR2.76 (95% CI 1.19–6.38) and stage IV CRC HR 11.02 (95% CI 4.44–27.37). Among patients with a recurrence, CEA ≥ 5 ng/mL was present in 63% of all recurrences, but less often in the potentially curable group (57% vs. 69%, p = 0.057). Median time to detection of a potentially curable recurrence was 16 months (IQR 20). The overall number needed to follow-up (NNFU) to detect one potentially curable recurrence was 9.8, with the lowest NNFU observed in stage IV CRC (2.3) and in rectal cancer (6.9). Conclusion: Standard follow-up enabled the detection of potentially curable recurrence in 8% of CRC patients. The substantial variation in NNFU across subgroups and the limited sensitivity of CEA underscore the need for more personalized, risk‑adapted surveillance strategies.
SN - 1932-6203
ER -