Sala-Miquel Noelia, Carrasco-Muñoz José, Bernabeu-Mira Soledad, Mangas-Sanjuan Carolina, Baile-Maxía Sandra, Madero-Velázquez Lucía, Ausina Victor, Yuste Ana, Gómez-González Lucía, Romero Simó Manuel, Zapater Pedro, Jover Rodrigo
Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain.
Department of Oncology, Hospital General Universitario Dr. Balmis, Alicante 03010, Valencia, Spain.
World J Gastroenterol. 2025 Mar 28;31(12):100155. doi: 10.3748/wjg.v31.i12.100155.
Evidence on adherence, diagnostic performance and impact on survival to intensive follow-up after surgery for colorectal cancer (CRC) is limited.
To analyze the diagnostic performance of surveillance colonoscopy, computed tomography (CT), and tumor markers (TMs) in detecting CRC recurrence or metastasis during follow-up after CRC resection. Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality.
The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015. Follow-up was performed using TMs every 6 months, yearly CT for 5 years, and colonoscopy at years 1 and 4. Demographic, primary tumor data, and results at follow-up were collected.
Of 574 included patients included, 153 had recurrences or metastases. Of this group, 136 (88.9%) were diagnosed by CT, 10 (6.5%) by CT and colonoscopy, and 7 (4.6%) by colonoscopy; only 67.8% showed TMs elevation. Adherence to follow-up recommendations was 68.8% for the first colonoscopy, 74% for the first CT scan, and 96.6% for the first blood test; these values declined over time. Younger age at diagnosis [odds ratio (OR) 0.93; 95%CI: 0.91-0.95], CRC stages I-II (OR 0.38; 95%CI: 0.24-0.61), and adherence to follow-up recommendations (OR 0.30; 95%CI: 0.20-0.46) were independently associated with lower risk for all-cause death at 5 years.
CT scan had the highest diagnostic yield. Adherence to follow-up recommendations was low and decreased during follow-up. Younger age at diagnosis, stage, and follow-up adherence were associated with lower 5-year mortality.
关于结直肠癌（CRC）手术后强化随访的依从性、诊断性能及其对生存的影响的证据有限。
分析结肠镜监测、计算机断层扫描（CT）和肿瘤标志物（TMs）在CRC切除术后随访期间检测CRC复发或转移的诊断性能。次要目标包括对临床实践指南监测建议的依从程度以及与依从性、全因死亡率和CRC死亡率相关的因素。
这项单中心回顾性队列研究纳入了2010年至2015年期间接受I-III期CRC根治性切除的患者。每6个月使用TMs进行随访，连续5年每年进行CT检查，在第1年和第4年进行结肠镜检查。收集人口统计学、原发肿瘤数据以及随访结果。
在纳入的574例患者中，153例出现复发或转移。在这组患者中，136例（88.9%）通过CT诊断，10例（6.5%）通过CT和结肠镜检查诊断，7例（4.6%）通过结肠镜检查诊断；只有67.8%的患者TMs升高。首次结肠镜检查的随访建议依从率为68.8%，首次CT扫描为74%，首次血液检查为96.6%；这些值随时间下降。诊断时年龄较小[比值比（OR）0.93；95%置信区间：0.91-0.95]、CRC I-II期（OR 0.38；95%置信区间：0.24-0.61）以及对随访建议的依从性（OR 0.30；95%置信区间：0.20-0.46）与5年全因死亡风险较低独立相关。
CT扫描的诊断率最高。对随访建议的依从性较低且在随访期间下降。诊断时年龄较小、分期以及随访依从性与5年死亡率较低相关。
