Harrison Hannah, Shah Bhumi K, Khan Faris, Batley Carley, Re Chiara, Rossi Sabrina H, Stimpson Georgia, Gilmore Eamonn, White Eleanor, Kler-Sangha Sofia, Espressivo Aufia, Pan Z Sienna, Rujeedawa Tanzil, Lamb Benjamin W, Succony Laura, Lam Shi, Zacharia Bincy M, Lucey Rebecca, Fulton Alexander J P, Kaludova Dimana, Balakrishnan Anita, Usher-Smith Juliet A, Stewart Grant D
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
BMJ Oncol. 2025 Mar 7;4(1):e000627. doi: 10.1136/bmjonc-2024-000627. eCollection 2025.
Identify and compare guidelines making recommendations for surveillance to detect recurrence in 16 common solid cancers after initial curative treatment in asymptomatic patients.
We conducted a systematic review, combining search results from two electronic databases, one guideline organisation website (NICE), expert consultation and manual searching. Screening and data extraction were carried out by multiple reviewers. We collected data from each guideline on recommendations for surveillance and the use of risk stratification. Findings were compared between cancer types and regions. Text mining was used to extract statements on the evidence for surveillance. A protocol was published on PROSPERO in 2021 (CRD42021289625).
We identified 123 guidelines across 16 cancer types. Almost all guidelines (n115, 93.5%) recommend routine surveillance for recurrent disease in asymptomatic patients after initial treatment. Around half (n=59, 51.3%) recommend indefinite or lifelong surveillance. The most common modality of surveillance was cross-sectional imaging. Risk stratification of frequency, length and mode of surveillance was widespread, with most guidelines (n92, 74.8%) recommending that surveillance be adapted based on patient risk. More than a third (n50, 39.0%) gave incomplete or vague recommendations. For 14 cancers, we found statements indicating there is no evidence that surveillance improves survival.
Although specific details of follow-up schedules vary, common challenges were identified across cancer types. These include heterogenous recommendations, vague or non-specific guidance and a lack of cited evidence supporting the use of surveillance to improve outcomes. Evidence generation in this area is challenging; however, increased availability to linked health records may provide a way forward.
CRD42021289625.
识别并比较针对无症状患者在初次根治性治疗后16种常见实体癌复发监测提出建议的指南。
我们进行了一项系统评价，综合了两个电子数据库、一个指南组织网站（英国国家卫生与临床优化研究所）的搜索结果、专家咨询以及手工检索。由多名评审员进行筛选和数据提取。我们从每个指南中收集了关于监测建议和风险分层使用的数据。对不同癌症类型和地区的研究结果进行了比较。采用文本挖掘技术提取关于监测证据的陈述。2021年在国际前瞻性系统评价注册库（PROSPERO）上发布了一项方案（注册号：CRD42021289625）。
我们共识别出针对16种癌症类型的123项指南。几乎所有指南（115项，93.5%）都建议对初次治疗后的无症状患者进行复发性疾病的常规监测。约一半（59项，51.3%）建议进行不确定或终身监测。最常见的监测方式是横断面成像。监测频率、时长和方式的风险分层很普遍，大多数指南（92项，74.8%）建议根据患者风险调整监测。超过三分之一（50项，39.0%）给出的建议不完整或含糊不清。对于14种癌症，我们发现有陈述表明没有证据支持监测可提高生存率。
尽管后续随访计划的具体细节各不相同，但在不同癌症类型中发现了一些共同挑战。这些挑战包括建议的异质性、含糊或不具体的指导以及缺乏支持使用监测来改善预后的引用证据。该领域的证据生成具有挑战性；然而，增加对关联健康记录的获取可能提供一条前进的道路。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42021289625。
