Follow-up strategies for patients treated for non-metastatic colorectal cancer

Jeffery, Mark; Hickey, Brigid E; Hider, Phil; See, Adrienne M

doi:10.1002/14651858.cd002200.pub3

Cited by 286 publications

(171 citation statements)

References 85 publications

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“…Interestingly, although multiple follow-up regimens have been suggested in literature with differences in both frequency of follow-up and components used at various time points, the intensity and components of the follow-up are still a matter of debate [7,8]. A recent systematic review concluded that intensive follow-up strategies were associated neither with improved cancer-specific survival, nor with a higher detection rate for tumour recurrences after curative treatment of CRC [9].…”

Section: Introductionmentioning

confidence: 99%

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Braak¹,

Lalmahomed²,

Büttner³

et al. 2017

Dig Dis

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Background/Aims: The 5-year postoperative follow-up for patients undergoing curative treatment for colorectal cancer (CRC) is labour intensive. We assessed the added value of a dedicated nonphysician clinician (NPC) in the follow-up of patients after resection for CRC. Methods: Patients were divided into 2 groups as defined by the number of follow-up visits in the first year, including intensive (≥3×) and minimal (≤2×). Involvement of an NPC, diagnosis of disease recurrence and the course of the disease were determined. Results: Of the 681 patients, 79.9% belonged to the “intensive” and 21.1% to the “minimal” group. Involvement of an NPC resulted in a higher adherence to follow-up (84.3 vs. 73.9%, p = 0.001). Overall, patients in regular follow-up less often had multifocal recurrence (47.1 vs. 73.7%, p = 0.04), and a better survival after recurrence (SAR; hazard ratio [HR] 3.604, p < 0.001). The “intensive” group had a significantly better overall survival compared to the “minimal” group (HR 1.71, p = 0.013). Conclusion: Adherence to surveillance programs after resection for CRC is better in hospitals with a dedicated NPC. Overall, patients' adherence to follow-up resulted in less multifocal disease recurrence at the time of diagnosis as compared to patients presenting with symptoms and a better 3-year SAR.

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Section: Introductionmentioning

confidence: 99%

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Braak¹,

Lalmahomed²,

Büttner³

et al. 2017

Dig Dis

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“…Two randomized control studies and a Cochrane meta-analysis of patients with colorectal cancer demonstrated no OS benefit with a more stringent follow-up protocol including thoracic cross-sectional imaging after surgery [19-21]. Nevertheless, recent recommendations on post-treatment surveillance of resected GEP-NENs based on the risk stratification of established prognostic factors allow for a more individualized, patient-tailored approach [22].…”

Section: Discussionmentioning

confidence: 99%

Lung Metastases in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Neoplasms: An Appraisal of the Validity of Thoracic Imaging Surveillance

et al. 2019

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Background/Aims: To evaluate the impact of lung metastases (LM) on overall survival (OS) in well-differentiated (WD) stage IV gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) patients along with developing surveillance strategies for thoracic imaging. Methods: Thirty-four patients with LM, from 3 centres, were identified (22 small intestine/12 pancreatic; 17 grade 1/15 grade 2/2 of unknown grade). For comparison, we used 106 stage IV WD, grade 1 and 2 GEP-NEN patients with metastatic disease confined in the abdomen. Results: LM prevalence was 4.9% (34/692). Eleven patients (32%) presented with synchronous LM whereas 23 (68%) developed metachronous LM at a median of 25 months (range 1–150 months). Patients with metachronous LM had already established liver and/or para-aortic lymph node metastases. Eighteen of 23 patients (78%) with metachronous LM exhibited concomitant progression in the abdomen. Median OS of WD GEP-NEN patients with LM was shorter than for those with stage IV disease without extra-abdominal metastases (56 [95% CI 40.6–71.6] vs. 122.7 [95% CI 70.7–174.8] months; log-rank p = 0.001). Among patients with progressive stage IV disease, the subset of patients with LM exhibited shorter OS (log-rank p = 0.005). LM were also confirmed as an independent prognostic factor for survival in multivariable analysis (HR 0.18; 95% CI 0.07–0.45; p < 0.0001). Conclusion: LM, although relatively rare in patients with WD stage IV GEP-NENs, may impact patients’ outcome. The development of metachronous LM is associated with concomitant disease progression in established abdominal metastases in most patients. These patient-related parameters could be utilized for a stratified surveillance approach, mainly reserving thoracic imaging for GEP-NEN patients with progressive disease in the abdomen.

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“…Trois méta-analyses ont montré une amélioration de la survie avec une surveillance « plus intensive » [2,4,37]. Ces trois méta-analyses se recoupent puisqu'elles regroupent à chaque fois quatre des principaux essais de surveillance publiés [3,[38][39][40].…”

Section: Recherche D'une Récidive Locale Ou Métastatiqueunclassified

“…Ces trois méta-analyses se recoupent puisqu'elles regroupent à chaque fois quatre des principaux essais de surveillance publiés [3,[38][39][40]. Il n'est donc pas étonnant que leurs résultats soient concordants, montrant qu'une surveillance intensive était associée à une réduction significative d'environ 20 % de la mortalité et à un diagnostic de récidive avancé sans toutefois de différence sur le nombre absolu de rechutes comme souligné dans l'étude néozélandaise [2].…”

Section: Recherche D'une Récidive Locale Ou Métastatiqueunclassified

Colon cancer: assessment and monitoring

Drouillard

Lepage

2014

Oncologie

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On pense intuitivement qu'en surveillant les malades on peut détecter des récidives asymptomatiques accessibles à une résection. Cette surveillance postopératoire des cancers colorectaux (CCR) opérés à visée curative reste mal codifiée en raison du petit nombre d'études randomisées publiées et surtout de leur manque de puissance. Cependant, les études les plus récentes suggèrent malgré leurs limites un gain de survie avec une surveillance clinique associée à une imagerie hépatique et pulmonaire et éventuellement au dosage de l'antigène carcinoembryonique (ACE). Les réci-dives endoluminales et les cancers métachrones sont rares : c'est la détection des récidives locorégionales et des méta-stases qui peut permettre d'améliorer la survie.Mots clés Diagnostic précoce · Survie · Imagerie · Marqueurs · Études randomisées Abstract Intuitively, it is assumed that by monitoring patients it is possible to detect resectable asymptomatic relapses. This curative post-operative follow-up of colorectal cancer surgery remains poorly validated due to the small number of published randomised studies and in particular their lack of statistical power. However, the most recent studies suggest that, in spite of their limitations, an increase in survival is seen with clinical follow-up combined with hepatic and pulmonary imaging and possibly analysis of ACE levels. Intraluminal relapses and metachronous tumours are rare: it is the detection of localised relapses and metastases that will enable improvements in survival.

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Follow-up strategies for patients treated for non-metastatic colorectal cancer

Abstract: Follow-up strategies for patients treated for non-metastatic colorectal cancer.

Cited by 286 publications

References 85 publications

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Lung Metastases in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Neoplasms: An Appraisal of the Validity of Thoracic Imaging Surveillance

Colon cancer: assessment and monitoring

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