Association Between Intensity of Posttreatment Surveillance Testing and Detection of Recurrence in Patients With Colorectal Cancer.
Association Between Intensity of Posttreatment Surveillance Testing and Detection of Recurrence in Patients With Colorectal Cancer.
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DOI：
10.1001/jama.2018.5816
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发表时间：
2018-05-22
期刊：
影响因子：
--
通讯作者：
Alliance for Clinical Trials in Oncology Network Cancer Surveillance Optimization Working Group
中科院分区：
文献类型：
--
作者：
Snyder RA;Hu CY;Cuddy A;Francescatti AB;Schumacher JR;Van Loon K;You YN;Kozower BD;Greenberg CC;Schrag D;Venook A;McKellar D;Winchester DP;Chang GJ;Alliance for Clinical Trials in Oncology Network Cancer Surveillance Optimization Working Group
监测测试是在结直肠癌（CRC）的主要治疗后进行的，但目前还不清楚这种测试是否会减少检测复发的时间或影响患者的生存。确定治疗后监测的强度是否与检测到CRC复发的时间、复发率、复发切除或总生存期（OS）相关。观察性回顾性队列研究。作为癌症委员会（CoC）特别研究的一部分，从病历中提取的患者数据与国家癌症数据库（NCDB）的记录合并。2006-2007年期间在CoC认证机构接受治疗的I-III期CRC患者的随机样本，随访至2014年12月31日。在3年观察期内，使用监测检测的预期与预期比值，在机构水平凭经验得出成像和癌胚抗原（CEA）监测检测的强度[较高（HI）和较低强度（LI）]。主要结果是检测到CRC复发的时间和复发率;次要结果包括复发性疾病的切除率和总生存率（OS）。1，175家机构的8529名患者在CRC治疗后3年内接受了监测成像和CEA检测。进行HI成像（49.1%）或CEA（48.5%）的患者平均进行了2.9次（95%CI 2.8-2.9）成像和4.3次（95%CI 4.2-4.4）CEA测试。LI患者平均接受1.6次（95% CI 1.6-1.7）成像和1.6次（95% CI 1.6-1.7）CEA检测。影像学检查发现复发的中位时间无差异[HI 15.1（95%CI 8.2-26.3）对比LI 16.0（95%CI 7.9-27.2）个月]或CEA强度[HI 15.9（95%CI 8.5-27.5）和LI 15.3（95%CI 7.9-25.7）个月]（p=0.60和p=0.39）。影像学和CEA监测强度与复发率的差异无关[HR 0.98（95% CI 0.89-1.09）和1.00（95%CI 0.90-1.10），复发切除[HR 0.99（95% CI 0.89-1.09）和HR 1.00（0.90-1.10）]或总生存期[HR 1.00（95% CI 0.94-1.08）和HR 0.96（95% CI 0.89-1.03）]。在接受I-III期结直肠癌治疗的患者中，监测强度与复发、切除或总生存率之间无显著相关性。
Surveillance testing is performed after primary treatment for colorectal cancer (CRC), but it is unclear if this testing decreases time to detection of recurrence or affects patient survival. To determine if intensity of post-treatment surveillance is associated with time to detection of CRC recurrence, rate of recurrence, resection for recurrence, or overall survival (OS). Observational retrospective cohort study. Patient data abstracted from the medical record as part of a Commission on Cancer (CoC) Special Study merged with records from the National Cancer Database (NCDB). Random sample of Stage I-III CRC patients treated at CoC accredited facilities during 2006–2007 with follow up through December 31, 2014. Intensity of imaging and carcinoembryonic antigen (CEA) surveillance testing [higher (HI) and lower intensity (LI)] derived empirically at the facility level using the observed–to-expected ratio for surveillance testing during a 3-year observation period. The primary outcome was time to detection of CRC recurrence and recurrence rates; secondary outcomes included rates of resection for recurrent disease and overall survival (OS). 8529 patients at 1,175 facilities underwent surveillance imaging and CEA testing in the 3 years after CRC treatment. Patients with HI imaging (49.1%) or CEA (48.5%) had a mean of 2.9 (95% CI 2.8–2.9) imaging and 4.3 (95% CI 4.2–4.4) CEA tests. Patients with LI underwent a mean of 1.6 (95% CI 1.6–1.7) imaging and 1.6 (95% CI 1.6–1.7) CEA tests. There was no difference in median time to detection of recurrence by imaging [HI 15.1 (95% CI 8.2–26.3) vs. LI 16.0 (95% CI 7.9–27.2) months] or CEA intensity [HI 15.9 (95% CI 8.5–27.5) and LI 15.3 (95% CI 7.9–25.7) months] (p=0.60 and p=0.39). Imaging and CEA surveillance intensity were not associated with a difference in recurrence rates [HR 0.98 (95% CI 0.89–1.09) and 1.00 (95% CI 0.90–1.10), recurrence resection [HR 0.99 (95% CI 0.89–1.09) and HR 1.00 (0.90–1.10)] or overall survival [HR 1.00 (95% CI 0.94–1.08) and HR 0.96 (95% CI 0.89–1.03)], respectively. Among patients treated for Stage I-III colorectal cancer, there was no significant association between surveillance intensity and recurrence, resection, or overall survival.
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