Treasure Tom, Milošević Mišel, Fiorentino Francesca, Pfannschmidt Joachim
Tom Treasure, Clinical Operational Research Unit, University College London, London WC1E 6BT, United Kingdom.
World J Gastroenterol. 2014 Oct 28;20(40):14517-26. doi: 10.3748/wjg.v20.i40.14517.
Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers, breast and lung, in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal. We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day. Our sources included published citation network analyses, the documented proposal for randomised trials, large systematic reviews, and meta-analysis of observational studies. The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done, or having been done, were not reported. Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias. Randomised controlled trials (RCTs) are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice. One such trial is recruiting and shows that controlled trial are possible.
转移性结直肠癌的临床实践与另外两种最常见的癌症——乳腺癌和肺癌不同，对于转移性结直肠癌，建议进行常规监测，其特定目的是检测肝转移和肺转移，并对其进行肝切除和肺切除以清除转移灶。我们通过回顾20世纪50年代至今的有效性证据，追溯了这种结直肠癌治疗方法的历史。我们的资料来源包括已发表的引文网络分析、随机试验的书面提案、大型系统评价以及观察性研究的荟萃分析。目前的共识立场是在大量观察性研究的基础上采纳的，但20世纪80年代和90年代提出的随机试验要么没有进行，要么进行了但未报告。临床意见是当前实践的主要依据，但在缺乏随机试验的情况下，仍有可能存在选择偏倚。现在，在采用新的治疗方法之前，随机对照试验（RCT）已成为常规操作，但在评估已确立的治疗方法时，进行随机对照试验则更加困难。一项此类试验正在招募受试者，并且表明进行对照试验是可行的。
