Hey mate, firstly I’d say - absolutely yes.
As you no doubt know, the recurrence/survival stats are based on the outcome of a large number of people. Of course your outcome will be binary - either you will or won’t have a recurrence, and nothing can tell you this definitively now. The question is, which side of the ‘recurrence’ plot will you fall on?
1. We think we’re getting pretty detailed talking about stage IIIc disease with a T3 tumour. However there are many other risk factors at play which I believe you are mostly on right side of - RAS/BRAF mutation (yours isn’t), T4 tumour (yours isn’t), EMVI+ (yours isn’t), perforation (nope), obstruction (don’t think so), no adjuvant chemo (not you), positive margins (nope), and fewer than 12 nodes sampled (no). The fact that you have essentially none of the higher risk factors for stage IIIc stands you in good stead to be on the right side of the recurrence/survival plot.
2. The survival/recurrence statistics are disgracefully outdated. This is particularly relevant for rectal primaries, where treatment has improved massively in the last 10-15 years. As an example, the MSK stats nomogram uses patient data from 1990-2000 - so 30 years ago for some patients! MD Anderson uses 1990-2005, so not much better. To compare, recent MSK trials are now showing 50-70% 5-year survival rates in their resected stage four patients, so I can only imagine how good the stage 3 stats must be.
3. Finally, as NHMike says, even if you did have a recurrence this is by no means the end of the road. Particularly given you will be on heavy surveillance, any issues are likely to be caught very early.
You make a good point about surveillance though. The German guidelines seem to be within but at the lighter end of the NCCN guideline range for stage III; personally I’d be pushing for 3 monthly CEAs, 6 monthly scans (at least for 2 years), and an annual scope. This is the more cautious end of the range.
Hope it all continues to go well.
Last edited by Rock_Robster
on Thu Jan 09, 2020 6:07 am, edited 1 time in total.
Male 37; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+
3 LN; 4 liver mets
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed a liver spot
08-11/19 - FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 - Liver resection #2
02/20 - Stoma reversal booked