Recurrence, death risk, and related factors in patients with stage 0 colorectal cancer: A nationwide population-based study

In this study, the National Health Insurance Research Database of Taiwan was used to examine the recurrence and death risk for stage 0 colorectal cancer patients. We examined stage 0 colorectal cancer patients to identify factors causing recurrence and death. This is a retrospective study, and stage 0 colorectal cancer patients that are registered in the Taiwan Cancer Registry of the Health Promotion Administration in 2007 to 2012 were included. The database was linked to the National Health Insurance Research Database, and subjects were followed up until the end of 2016. The mean follow-up period was 69 months. Bivariate analysis methods (log-rank test) and Cox proportional hazards model were used to evaluate the risk of recurrence and death and demographic characteristics, economic factors, environmental factors, health factors, treatment and hospitals, and absence/presence of postoperative tests were used to examine related risk factors. Our study showed that the 5-year recurrence rate and 5-year mortality rate for stage 0 colorectal cancer are 1.68% and 0.6%, respectively. For stage 0 colorectal cancer, age (61–74 years) is the only factor affecting recurrence in patients (hazard ratio (HR) = 2.44; 95% CI: 1.41–4.22), while age >75 years (HR = 4.35; 95% CI: 1.14–16.68) and Charlson Comorbidity Index >4 points (HR = 7.20, 95% CI: 2.60–19.94) can increase the risk of death. In contrast, patients who underwent one (HR = 0.27, 95% CI: 0.10–0.71) and two or more colonoscopies (HR = 0.26, 95% CI: 0.10–0.70) within 2 years after surgery can reduce the risk of death from stage 0 colorectal cancer. In addition, the risk of recurrence is higher in patients who underwent colonoscopic polypectomy (HR = 2.07, 95% CI: 0.98–4.33) and patients with rectal cancer (HR = 2.74, 95% CI: 0.96–7.83), but these differences are not statistically significant (P > .05). From this study, we can see that age and comorbidity index increase the risk of recurrence and death for stage 0 colorectal cancer, while postoperative colonoscopy can decrease the risk of death.