Follow-Up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement
Follow-Up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement
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DOI：
10.1200/jco.2013.50.7442
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发表时间：
2013-12-10
影响因子：
45.3
通讯作者：
Benson, Al B., III
中科院分区：
文献类型：
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作者：
Meyerhardt, Jeffrey A.;Mangu, Pamela B.;Benson, Al B., III
目的美国临床肿瘤学会(ASCO)有一套政策和程序来认可最近由其他专业组织制定的临床实践指南。方法美国临床肿瘤学会(ASCO)对《安大略省癌症护理指南》(CCO)关于结直肠癌幸存者的后续护理、监测方案和二级预防措施的指南进行了方法学严谨的审查，并考虑予以认可。结果ASCO小组同意CCO的建议和推荐的认可，并增加了几项限定性声明。结论监测应以假定的复发风险和患者的功能状态为指导(在最初的2-4年内是重要的)。病史、体检和癌胚抗原检测应每隔3至6个月进行一次，持续5年。复发风险较高的患者应考虑在范围内较频繁的一端进行检测。在大多数情况下，建议每年进行一次计算机断层扫描(腹部和胸部)，为期3年。正电子发射断层扫描不应用于临床试验以外的监测。监视结肠镜检查应在初次手术后1年进行，然后根据前一次检查结果每隔5年进行一次。如果在诊断前没有进行结肠镜检查，应在辅助治疗结束后(1年前)进行。建议进行二级预防(保持健康的体重和积极的生活方式)。如果患者因为严重的合并症而不适合接受手术或系统治疗，则不应进行监测测试。专科医生的治疗计划应该对非专科医生的适当随访有明确的指导。
Purpose The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing recent clinical practice guidelines that have been developed by other professional organizations.Methods The Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer was reviewed by ASCO for methodologic rigor and considered for endorsement.Results The ASCO Panel concurred with the CCO recommendations and recommended endorsement, with the addition of several qualifying statements.Conclusion Surveillance should be guided by presumed risk of recurrence and functional status of the patient (important within the first 2 to 4 years). Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. Patients at higher risk of recurrence should be considered for testing in the more frequent end of the range. A computed tomography scan (abdominal and chest) is recommended annually for 3 years, in most cases. Positron emission tomography scans should not be used for surveillance outside of a clinical trial. A surveillance colonoscopy should be performed 1 year after the initial surgery and then every 5 years, dictated by the findings of the previous one. If a colonoscopy was not preformed before diagnosis, it should be done after completion of adjuvant therapy (before 1 year). Secondary prevention (maintaining a healthy body weight and active lifestyle) is recommended. If a patient is not a candidate for surgery or systemic therapy because of severe comorbid conditions, surveillance tests should not be performed. A treatment plan from the specialist should have clear directions on appropriate follow-up by a nonspecialist.