Work

Postoperative surveillance strategy in patients undergoing neoadjuvant chemoradiotherapy followed by curative resection for locally advanced rectal cancer

Year: 2026

Type: article

Abstract: Background There are no consistent recommendations for postoperative surveillance intervals for rectal cancer in the major guidelines. Knowledge about recurrence hazards can help develop appropriate surveillance schedules. This study aimed to investigate transitions in recurrence hazard and peak recurrence time in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT). Methods Between 2011 and 2016, 785 consecutive patients with LARC who underwent nCRT and curative resection were analyzed. The hazard rates of recurrence were calculated using the hazard function. Potential risk factors for recurrence were assessed. Results The recurrence rates of patients with stage I or pathological complete response (pCR), stage II and stage III were 10.7% (39/366), 22.9% (48/210) and 45.9% (96/209), respectively. The hazard curve for stage I or pCR was relatively flat, and the hazard rates were consistently low (< 0.003) for 5 years after surgery. The hazard curve for stage II was higher than that of stage I or pCR and gradually decreased with a long tail to the right (< 0.007). The hazard curve for stage III was bimodal, with two peaks at 8 and 36 months (peak hazard rates: 0.0193 and 0.0077). Multivariate analysis identified distance from anal verge, maximum tumor diameter, ypTNM stage and perineural invasion as independent risk factors for recurrence. Among 183 patients with recurrence, 54 (29.5%) met criteria for potentially curable recurrence, and 48 (88.9%) of these received curative‑intent treatment. Earlier detection (≤ 24 months) was not associated with a higher probability of curative‑intent treatment ( P = 0.124) nor with improved post‑recurrence survival in patients receiving curative‑intent treatment ( P = 0.331). Conclusion Recurrence hazard after nCRT and surgery for LARC varies significantly by pathological stage. These findings may help guide postoperative surveillance, particularly supporting continued vigilance beyond 2 years after surgery for patients with stage III disease.

Source: BMC Cancer

DOI: 10.1186/s12885-026-16498-x