Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Pulmonology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Eur J Cancer. 2022 Oct;174:185-199. doi: 10.1016/j.ejca.2022.07.025. Epub 2022 Aug 27.
This meta-analysis aimed to evaluate the effectiveness of intensive follow-up after curative intent treatment for five common solid tumours, in terms of survival and treatment of recurrences.
A systematic literature search was conducted, identifying comparative studies on follow-up for colorectal, lung, breast, upper gastro-intestinal and prostate cancer. Outcomes of interest were overall survival (OS), cancer specific survival (CSS), and treatment of recurrences. Random effects meta-analyses were conducted, with particular focus on studies at low risk of bias.
Fourteen out of 63 studies were considered to be at low risk of bias (8 colorectal, 4 breast, 0 lung, 1 upper gastro-intestinal, 1 prostate). These studies showed no significant impact of intensive follow-up on OS (hazard ratio, 95% confidence interval) for colorectal (0.99; 0.92-1.06), breast 1.06 (0.92-1.23), upper gastro-intestinal (0.78; 0.51-1.19) and prostate cancer (1.00; 0.86-1.16). No impact on CSS (hazard ratio, 95% confidence interval) was found for colorectal cancer (0.94; 0.77-1.16). CSS was not reported for other cancer types. Intensive follow-up increased the rate of curative treatment (relative risk; 95% confidence interval) for colorectal cancer recurrences (1.30; 1.05-1.61), but not for upper gastro-intestinal cancer recurrences (0.92; 0.47-1.81). For the other cancer types, no data on treatment of recurrences was available in low risk studies.
For colorectal and breast cancer, high quality studies do not suggest an impact of intensive follow-up strategies on survival. Colorectal cancer recurrences are more often treated locally after intensive follow-up. For other cancer types evaluated, limited high quality research on follow-up is available.
本荟萃分析旨在评估在有治愈意图的治疗后进行强化随访，对五种常见实体瘤的生存和复发治疗的有效性。
系统地进行文献检索，以确定关于结直肠癌、肺癌、乳腺癌、上胃肠道癌和前列腺癌随访的比较研究。感兴趣的结局包括总生存（OS）、癌症特异性生存（CSS）和复发治疗。进行了随机效应荟萃分析，特别关注低偏倚风险的研究。
在 63 项研究中，有 14 项被认为是低偏倚风险的（8 项结直肠癌、4 项乳腺癌、0 项肺癌、1 项上胃肠道癌、1 项前列腺癌）。这些研究显示，强化随访对 OS（危险比，95%置信区间）没有显著影响，结直肠癌（0.99；0.92-1.06）、乳腺癌（1.06；0.92-1.23）、上胃肠道癌（0.78；0.51-1.19）和前列腺癌（1.00；0.86-1.16）。未发现 CSS（危险比，95%置信区间）有影响，结直肠癌（0.94；0.77-1.16）。其他癌症类型未报告 CSS。强化随访增加了结直肠癌复发的治愈治疗率（相对风险；95%置信区间）（1.30；1.05-1.61），但对上胃肠道癌复发无影响（0.92；0.47-1.81）。对于其他癌症类型，低风险研究中没有关于复发治疗的数据。
对于结直肠癌和乳腺癌，高质量的研究表明强化随访策略对生存没有影响。结直肠癌强化随访后更常进行局部治疗。对于评估的其他癌症类型，随访的高质量研究有限。
