Mount Sinai Hospital, 600 University Ave., Toronto, ON M5G 1X5, Canada.
Program in Evidence-Based Care, McMaster University, 1280 Main St. W, Hamilton, ON L8S 4L8, Canada.
Curr Oncol. 2022 Jan 30;29(2):724-740. doi: 10.3390/curroncol29020062.
To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I-IV colon and rectal cancer.
Consistent with the Program in Evidence-Based Care's standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users.
Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations.
For patients with stage I-III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT CAP could be performed at 18 months; the use of carcinoembryonic antigen (CEA) is optional if CT imaging is being performed; and surveillance colonoscopy should be performed one year after the initial surgery. The frequency of subsequent surveillance colonoscopy should be dictated by previous findings, but generally, colonoscopies should be performed every five years if the findings are normal. There was insufficient evidence to support these recommendations for patients with rectal cancer, Stage IV colon cancer, and patients over the age of 75 years. Patients should be informed of current recommendations and the treating physician should discuss the specific risks and benefits of each recommendation with their patients.
为根治性治疗 I-IV 期结肠癌和直肠癌患者提供监测方案建议，以获得最大的总生存获益。
与循证护理计划的标准方法一致，系统地搜索了指南数据库，即 MEDLINE、EMBASE、PubMed、Cochrane 图书馆和 PROSPERO。然后，我们起草了建议，方法学专家对建议草案进行了内部审查，随后由目标专家和预期用户进行了外部审查。
确定了四项系统评价和两项随机对照试验，为建议提供了证据。
对于 I-III 期结肠癌患者，病史和体检应每六个月进行一次，持续三年；胸部-腹部-骨盆 CT（CT CAP）应在一年和三年进行，或在 18 个月时进行一次 CT CAP；如果进行 CT 成像，则可以选择使用癌胚抗原（CEA）；初始手术后应进行一次结肠镜检查。后续结肠镜检查的频率取决于先前的发现，但如果结果正常，通常每五年进行一次结肠镜检查。对于直肠癌、IV 期结肠癌和 75 岁以上的患者，没有足够的证据支持这些建议。应告知患者当前的建议，并由治疗医生与患者讨论每项建议的具体风险和收益。
