Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
Chin Med J (Engl). 2024 Sep 5;137(17):2017-2039. doi: 10.1097/CM9.0000000000003253. Epub 2024 Aug 6.
The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established.
This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency.
This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines.
The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.
近年来，中国结直肠癌（CRC）的发病率和死亡率呈上升趋势。CRC 的发病机制已明确，癌前病变可检测，这使得 CRC 的预防、筛查和早期诊断成为可能。随着内镜和外科技术的发展，早期 CRC 的治疗选择也值得进一步探讨，因此需要建立治疗后的标准随访方案。
本临床实践指南（CPG）的制定遵循世界卫生组织的推荐流程，采用评估、制定与评价分级（GRADE）方法评估证据质量，并使用证据决策框架制定临床推荐，从而最大限度地减少偏倚，提高 CPG 制定过程的透明度。我们使用卫生保健实践指南报告条目（RIGHT）声明和评估指南研究与评价 II（AGREE II）作为报告和实施指南，以确保指南的完整性和透明度。
本 CPG 包含 46 条关于 CRC 的预防、筛查、诊断、治疗和监测的建议。在这些建议中，我们指出了 CRC 的保护和危险因素，并提出了化学预防的建议。我们根据中国国情提出了适合 CRC 的筛查方案。我们还根据现有临床证据和指南为 CRC 的诊断、治疗和监测提供了规范说明。
本 CPG 中的 46 条建议考虑了利益相关者的价值观和偏好、可行性和可接受性。这些建议具有普遍适用性，可推广应用于具有类似 CRC 流行病学特征的资源有限的环境中。
