Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Follow Up, Lifestyle and Survivorship
Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Follow Up, Lifestyle and Survivorship
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DOI：
10.1111/codi.13706
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发表时间：
2017-07-01
影响因子：
3.4
通讯作者：
Karandikar, Sharad
中科院分区：
文献类型：
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作者：
Leong, Kai;Hartley, John;Karandikar, Sharad
先前对根治性结直肠癌切除术后随访的随机对照试验的荟萃分析显示，接受“强化”随访的患者的生存获益，与“不太强化”随访相比，比值比分别为0.73（95%CI：0.59-0.91）和0.74（95%CI：0.59-0.93）（Jeffery et al.，2007; Tjandra & Chan，2007）。在强化随访组中，复发时间缩短，进行了更具治愈性的外科手术，但对于什么是“强化”随访没有达成共识。最近的一项荟萃分析发现，尽管强化监测导致复发性疾病的早期检测，中位数为10个月，但与“不太强化”的监测方案相比，这并没有赋予任何生存优势（Mokhles et al.，2016年）。有证据表明，血清癌胚抗原（CEA）和CT成像是两个调查，有显着的潜力，以检测可治疗的转移复发的结直肠癌患者。由于这些试验存在显著异质性，本指南无法推荐随访研究的最佳频率和持续时间。FACS试验报告，在接受原发性结直肠癌根治性手术的患者中，（每6个月进行一次胸部、腹部和骨盆CT检查，持续2年，然后每年进行一次，持续3年）或CEA筛查（每3个月一次血清CEA，持续2年，然后每6个月一次，持续3年）与最小随访相比，每种治疗方法都提高了可治愈的复发率;联合CEA和CT没有额外的优点（报春花等人，2014年）。
Previous meta-analyses of randomized controlled trials of follow up after curative colorectal cancer resection have shown survival benefit in patients undergoing ‘intensive’follow up, with odds ratio of 0.73 (95% CI 0.59–0.91) and 0.74 (95% CI: 0.59–0.93) respectively over ‘less intensive’follow up (Jeffery et al., 2007; Tjandra & Chan, 2007). There was a reduction in the time to recurrence and more curative surgical procedures performed in the intensively followed up arm but there is no consensus as to what constitutes ‘intensive’follow up. A more recent meta-analysis has found that although intensive monitoring resulted in earlier detection of recurrent disease by a median of 10 months, this did not confer any survival advantage over ‘less intensive’monitoring protocols (Mokhles et al., 2016). Evidence suggests that serum carcinoembryonic antigen (CEA) and CT imaging are the two investigations that have significant potential to detect treatable metastatic recurrence in patients with colorectal cancer. Due to significant heterogeneity in these trials, this guideline is unable to recommend the optimal frequency and duration of follow up investigations. The FACS trial reported that in patients who had undergone curative surgery for primary colorectal cancer, intensive CT imaging (CT of the chest, abdomen, and pelvis every 6 months for 2 years, then annually for 3 years) or CEA screening (serum CEA every 3 months for 2 years, then every 6 months for 3 years) each provided an improved rate of detected recurrence treatable with curative intent compared with minimal follow-up; there was no additional advantage in combining CEA and CT (Primrose et al., 2014).