ArticleFrontiers in oncology2026
Temporal dynamics and determinants of early recurrence after curative resection for stage I-III rectal cancer: integrated analyses of hazard function, survival, and competing risks.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Recurrence after curative resection remains a major determinant of long-term outcome in rectal cancer. However, the temporal pattern of postoperative recurrence, the determinants of early recurrence, and their relationships with survival and recurrence patterns have not been fully characterized. This study aimed to define the time distribution of recurrence after curative surgery for stage I-III rectal cancer, identify factors associated with early recurrence, and examine their links with long-term outcomes and recurrence patterns. Methods: We retrospectively included 1,045 patients with stage I-III rectal cancer who underwent curative surgery between January 1, 2014, and April 30, 2019. Smoothed hazard curves were used to identify the high-risk window for early recurrence. Logistic regression in an adequate-follow-up cohort was used to analyze early recurrence, Cox regression to evaluate time-to-recurrence (TTR) and overall survival (OS), and cumulative incidence functions with Fine-Gray models to assess local recurrence and distant metastasis. Results: Recurrence hazard peaked at approximately 24 months after surgery. With recurrence within 24 months defined as early recurrence, multivariable logistic regression identified lymph node ratio (LNR; per 0.1 increase: OR = 1.36, 95% CI 1.18-1.57, P < 0.001) and T4 stage (OR = 2.74, 95% CI 1.13-6.65, P = 0.026) as independent correlates. In multivariable Cox analyses, LNR, T4 stage, and carcinoembryonic antigen were independently associated with worse TTR, whereas LNR, T4 stage, carcinoembryonic antigen, and poor/undifferentiated differentiation were independently associated with worse OS. Distant metastasis consistently exceeded local recurrence during follow-up. Fine-Gray analysis showed that LNR (per 0.1 increase: sHR = 1.25, 95% CI 1.13-1.38, P < 0.001) and T4 stage (sHR = 4.22, 95% CI 1.77-10.05, P = 0.001) were independently associated with distant metastasis; the local-recurrence model was exploratory because of limited events. Conclusions: Recurrence after curative resection for rectal cancer showed clear temporal dynamics and peaked at approximately 24 months. LNR and T4 stage were the most consistent correlates across early recurrence, long-term outcomes, and distant metastasis, supporting further evaluation of risk-stratified postoperative surveillance based on time window and pathological risk burden.
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