Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston.
Department of Surgery, University of South Carolina School of Medicine, Greenville.
JAMA. 2018 May 22;319(20):2104-2115. doi: 10.1001/jama.2018.5816.
Surveillance testing is performed after primary treatment for colorectal cancer (CRC), but it is unclear if the intensity of testing decreases time to detection of recurrence or affects patient survival.
To determine if intensity of posttreatment surveillance is associated with time to detection of CRC recurrence, rate of recurrence, resection for recurrence, or overall survival.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of patient data abstracted from the medical record as part of a Commission on Cancer Special Study merged with records from the National Cancer Database. A random sample of patients (n=8529) diagnosed with stage I, II, or III CRC treated at a Commission on Cancer-accredited facilities (2006-2007) with follow-up through December 31, 2014.
Intensity of imaging and carcinoembryonic antigen (CEA) surveillance testing 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; secondary outcomes included rates of resection for recurrent disease and overall survival.
A total of 8529 patients (49% men; median age, 67 years) at 1175 facilities underwent surveillance imaging and CEA testing within 3 years after their initial CRC treatment. The cohort was distributed by stage as follows: stage I, 25.0%; stage II, 35.2%; and stage III, 39.8%. Patients treated at high-intensity facilities-4188 patients (49.1%) for imaging and 4136 (48.5%) for CEA testing-underwent a mean of 2.9 (95% CI, 2.8-2.9) imaging scans and a mean of 4.3 (95% CI, 4.2-4.4) CEA tests. Patients treated at low-intensity facilities-4341 patients (50.8%) for imaging and 4393 (51.5%) for CEA testing-underwent a mean of 1.6 (95% CI, 1.6-1.7) imaging scans and a mean of 1.6 (95% CI, 1.6-1.7) CEA tests. Imaging and CEA surveillance intensity were not associated with a significant difference in time to detection of cancer recurrence. The median time to detection of recurrence was 15.1 months (IQR, 8.2-26.3) for patients treated at facilities with high-intensity imaging surveillance and 16.0 months (IQR, 7.9-27.2) with low-intensity imaging surveillance (difference, -0.95 months; 95% CI, -2.59 to 0.68; HR, 0.99; 95% CI, 0.90-1.09) and was 15.9 months (IQR, 8.5-27.5) for patients treated at facilities with high-intensity CEA testing and 15.3 months (IQR, 7.9-25.7) with low-intensity CEA testing (difference, 0.59 months; 95% CI, -1.33 to 2.51; HR, 1.00; 95% CI, 0.90-1.11). No significant difference existed in rates of resection for cancer recurrence (HR for imaging, 1.22; 95% CI, 0.99-1.51 and HR for CEA testing, 1.12; 95% CI, 0.91-1.39) or overall survival (HR for imaging, 1.01; 95% CI, 0.94-1.08 and HR for CEA testing, 0.96; 95% CI, 0.89-1.03) among patients treated at facilities with high- vs low-intensity imaging or CEA testing surveillance.
Among patients treated for stage I, II, or III CRC, there was no significant association between surveillance intensity and detection of recurrence.
clinicaltrials.gov Identifier: NCT02217865.
结直肠癌（CRC）初次治疗后进行监测性检测，但尚不清楚检测强度的降低是否会影响复发的检出时间或影响患者的生存。
确定治疗后监测的强度是否与 CRC 复发的检出时间、复发率、复发后的切除术或总生存率相关。
设计、地点和参与者：这是一项回顾性队列研究，对从癌症委员会特别研究的病历中提取的患者数据进行了分析，该研究与国家癌症数据库中的记录合并。从癌症委员会认可的设施（2006-2007 年）接受治疗且随访至 2014 年 12 月 31 日的 I、II 或 III 期 CRC 患者的随机样本（n=8529）。
通过在 3 年观察期内使用观察到的与预期的监测检测比值，从机构水平推导出成像和癌胚抗原（CEA）监测检测的强度。
主要结局是 CRC 复发的检出时间；次要结局包括因复发疾病而进行切除术的比率和总生存率。
共有 8529 名患者（49%为男性；中位年龄 67 岁）在 1175 家机构接受了初次 CRC 治疗后 3 年内的监测成像和 CEA 检测。该队列的分布如下：I 期 25.0%，II 期 35.2%，III 期 39.8%。在高强度设施接受治疗的患者（4188 名患者进行成像检查，4136 名患者进行 CEA 检查）的平均接受了 2.9（95%CI，2.8-2.9）次成像扫描和 4.3（95%CI，4.2-4.4）次 CEA 检查。在低强度设施接受治疗的患者（4341 名患者进行成像检查，4393 名患者进行 CEA 检查）的平均接受了 1.6（95%CI，1.6-1.7）次成像扫描和 1.6（95%CI，1.6-1.7）次 CEA 检查。成像和 CEA 监测强度与癌症复发的检出时间之间没有显著差异。在高强度成像监测设施接受治疗的患者中，中位复发检出时间为 15.1 个月（IQR，8.2-26.3），在低强度成像监测设施接受治疗的患者中，中位复发检出时间为 16.0 个月（IQR，7.9-27.2）（差异，-0.95 个月；95%CI，-2.59 至 0.68；HR，0.99；95%CI，0.90-1.09）；在高强度 CEA 检测设施接受治疗的患者中，中位复发检出时间为 15.9 个月（IQR，8.5-27.5），在低强度 CEA 检测设施接受治疗的患者中，中位复发检出时间为 15.3 个月（IQR，7.9-25.7）（差异，0.59 个月；95%CI，-1.33 至 2.51；HR，1.00；95%CI，0.90-1.11）。在高强度与低强度成像或 CEA 检测监测设施接受治疗的患者中，复发切除术的比率（成像，HR 为 1.22；95%CI，0.99-1.51；CEA 检测，HR 为 1.12；95%CI，0.91-1.39）或总生存率（成像，HR 为 1.01；95%CI，0.94-1.08；CEA 检测，HR 为 0.96；95%CI，0.89-1.03）均无显著差异。
在接受 I、II 或 III 期 CRC 治疗的患者中，监测强度与复发的检出之间没有显著关联。
clinicaltrials.gov 标识符：NCT02217865。
