Tjandra Joe J, Chan Miranda K Y
Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Hospitals, University of Melbourne, Melbourne, Australia.
Dis Colon Rectum. 2007 Nov;50(11):1783-99. doi: 10.1007/s10350-007-9030-5.
This is a systematic review to evaluate the impact of various follow-up intensities and strategies on the outcome of patients after curative surgery for colorectal cancer.
All randomized trials up to January 2007, comparing different follow-up intensities and strategies, were retrieved. Meta-analysis was performed by using the Forest plot review.
Eight randomized, clinical trials with 2,923 patients with colorectal cancer undergoing curative resection were reviewed. There was a significant reduction in overall mortality in patients having intensive follow-up (intensive vs. less intensive follow-up: 21.8 vs. 25.7 percent; P = 0.01). Regular surveillance with serum carcinoembryonic antigen (P = 0.0002) and colonoscopy (P = 0.04) demonstrated a significant impact on overall mortality. However, cancer-related mortality did not show any significant difference. There was no significant difference in all-site recurrence and in local or distant metastasis. Detection of isolated local and hepatic recurrences was similar. Intensive follow-up detected asymptomatic recurrence more frequently (18.9 vs. 6.3 percent; P < 0.00001) and 5.91 months earlier than less intensive follow-up protocol; these were demonstrated with all investigation strategies used. Intensive surveillance program detected recurrences that were significantly more amenable to surgical reresection (10.7 vs. 5.7 percent; P = 0.0002). The chance of curative reresection were significantly better with more intensive follow-up (24.3 vs. 9.9 percent; P = 0.0001), independent of the investigation strategies used.
Intensive follow-up after curative resection of colorectal cancer improved overall survival and reresection rate for recurrent disease. However, the cancer-related mortality was not improved and the survival benefit was not related to earlier detection and treatment of recurrent disease.
本系统评价旨在评估不同随访强度和策略对结直肠癌根治性手术后患者结局的影响。
检索截至2007年1月比较不同随访强度和策略的所有随机试验。采用森林图回顾进行荟萃分析。
回顾了8项随机临床试验，共2923例接受根治性切除的结直肠癌患者。强化随访患者的总死亡率显著降低（强化随访与非强化随访：21.8%对25.7%；P = 0.01）。血清癌胚抗原定期监测（P = 0.0002）和结肠镜检查（P = 0.04）对总死亡率有显著影响。然而，癌症相关死亡率无显著差异。全部位复发、局部或远处转移均无显著差异。孤立性局部和肝复发的检出情况相似。强化随访更频繁地检测到无症状复发（18.9%对6.3%；P < 0.00001），比非强化随访方案早5.91个月；所有使用的调查策略均证实了这一点。强化监测方案检测到的复发更适合手术再切除（10.7%对5.7%；P = 0.0002）。强化随访的根治性再切除机会显著更好（24.3%对9.9%；P = 0.0001），与所使用的调查策略无关。
结直肠癌根治性切除术后强化随访可提高总体生存率和复发性疾病的再切除率。然而，癌症相关死亡率并未改善，生存获益与复发性疾病的早期检测和治疗无关。
