Evaluation of Prognostic Factors in pT4 Colorectal Cancer Recurrence: A Cohort Study

Abstract

Background: Colorectal cancer is among the most common cancers worldwide. Surgical resection remains the standard treatment. Patients with a pathological diagnosis of T4 malignancy are at greater risk of recurrence after curative-intent surgery according to specific features. Understanding those factors of recurrence is important for improving prognosis. Objective: We aimed to analyze patient features that could lead to a statistically higher recurrence of colorectal cancer and to elaborate a predictive nomogram. Design: A retrospective cohort study. Settings: The patients' data were collected from medical records of the Local Health Unit São João, in Porto, Portugal. Patients: Our study included ninety-three patients with a pathological diagnosis of T4 colorectal cancer who underwent curative-intent surgery between January 2018 and December 2022. Main Outcome Measures: We examined sociodemographic, histopathological, and oncological outcome features of recurrent and non-recurrent patients. Results: Recurrence after surgery occurred in thirty-seven patients. Multivariate analysis showed two independent risk factors: lymph node ratio higher than 0.059 (OR, 2.732; 95% CI, 1.059 - 7.048; p = 0.04) and radial margin of less than 8.5 mm (OR, 3.315; 95% CI, 1.202 - 9.147; p = 0.02); these variables were then included in the predictive nomogram. Limitations: This study analyzed a relatively small population during a short follow-up period. The missing data on medical records may limit the applicability of our results. Other variables that could have led to different conclusions were not included in the statistical analysis. Conclusions: The inclusion of the lymph node ratio and the radial margin in the prediction of recurrence may benefit the prognosis of these patients, providing personalized disease management.