结肠镜检查、影像学检查和癌胚抗原：接受结直肠癌切除患者的监测策略指南依从性比较——一项系统评价和荟萃分析
Colonoscopy, imaging, and carcinoembryonic antigen: Comparison of guideline adherence to surveillance strategies in patients who underwent resection of colorectal cancer - A systematic review and meta-analysis.
作者信息
Dawood Zaiba Shafik, Hamad Ahmad, Moazzam Zorays, Alaimo Laura, Lima Henrique A, Shaikh Chanza, Munir Muhammad Musaab, Endo Yutaka, Pawlik Timothy M
机构信息
Medical College, The Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
出版信息
Surg Oncol. 2023 Apr;47:101910. doi: 10.1016/j.suronc.2023.101910. Epub 2023 Feb 14.
INTRODUCTION
Almost one-third of patients with colorectal cancer (CRC) experience recurrence after resection. Adherence to surveillance guidelines largely dictates efficacy in early detection of recurrence. We sought to assess and compare adherence to postoperative surveillance guidelines for colonoscopy, imaging, and Carcinoembryonic Antigen (CEA).
METHODS
PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, and CINAHL were systematically searched. Random-effects meta-analysis was performed and pooled adherence to each surveillance strategy was assessed for CEA, imaging, and colonoscopy.
RESULTS
Overall 14 studies (55,895 patients) met the inclusion criteria. Adherence to colonoscopy guidelines was the highest (70%, 95%CI 67-73), followed by imaging (63%, 95%CI 47-80), and CEA (54%; 95%CI 42-66). Among 7 (50%) studies that examined adherence to the American Society of Clinical Oncology guidelines, compliance with colonoscopy was the highest (73%; 95% CI 70-76), followed by imaging (58%; 95% CI 37-78), and CEA (45%; 95%CI 37-52). Of note, guideline adherence to CEA testing was much lower than colonoscopy among patients with colon (OR 0.21; 95%CI 0.20-0.22) and rectal cancer (OR 0.25; 95%CI 0.23-0.28) (both p < 0.05). This was also noted when compared with imaging recommendations among older patients (OR = 0.62; 95%CI 0.42-0.93) and patients with stage II, (OR = 0.80; 95%CI 0.76-0.84) and stage III disease (OR = 0.88; 95%CI 0.82-0.94) (all p < 0.05).
CONCLUSION
While guideline adherence to postoperative surveillance with colonoscopy was high, adherence to CEA testing and imaging surveillance strategies was markedly lower following CRC resection. Future studies should investigate avenues to improve compliance with surveillance guidelines among health care providers and patients to optimize postoperative follow-up for CRC.
引言
近三分之一的结直肠癌（CRC）患者在切除术后会出现复发。遵循监测指南在很大程度上决定了早期复发检测的效果。我们旨在评估和比较结肠镜检查、影像学检查以及癌胚抗原（CEA）术后监测指南的遵循情况。
方法
对PubMed、Medline、Embase、Scopus、Cochrane、Web of Science和CINAHL进行系统检索。进行随机效应荟萃分析，并评估CEA、影像学检查和结肠镜检查对每种监测策略的综合遵循情况。
结果
共有14项研究（55895例患者）符合纳入标准。对结肠镜检查指南的遵循率最高（70%，95%置信区间67 - 73），其次是影像学检查（63%，95%置信区间47 - 80），CEA检查为（54%；95%置信区间42 - 66）。在7项（50%）检查遵循美国临床肿瘤学会指南情况的研究中，结肠镜检查的依从性最高（73%；95%置信区间70 - 76），其次是影像学检查（58%；95%置信区间37 - 78），CEA检查为（45%；95%置信区间37 - 52）。值得注意的是，结肠癌患者（比值比0.21；95%置信区间0.20 - 0.22）和直肠癌患者（比值比0.25；95%置信区间0.23 - 0.28）中，CEA检测的指南遵循率远低于结肠镜检查（均p < 0.05）。在老年患者（比值比 = 0.62；95%置信区间0.42 - 0.93）以及II期（比值比 = 0.80；95%置信区间0.76 - 0.84）和III期疾病患者（比值比 = 0.88；95%置信区间0.82 - 0.94）中与影像学检查建议相比时也有此发现（均p < 0.05）。
结论
虽然结肠镜检查术后监测的指南遵循率较高，但CRC切除术后CEA检测和影像学监测策略的遵循率明显较低。未来的研究应探索提高医疗保健提供者和患者对监测指南遵循率的途径，以优化CRC的术后随访。
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