Postoperative Surveillance in Patients With Colorectal Cancer Who Have Undergone Curative Resection: A Prospective, Multicenter, Randomized, Controlled Trial

Rodríguez-Moranta, Francisco; Saló, Joan; Arcusa, Àngels; Boadas, Jaume; Piñol, Virgı́nia; Bessa, Xavier; Batiste-Alentorn, E.; Lacy, Antonio M.; Delgado, Salvadora; Maurel, Joan; Piqué, Josep M.; Castells, Antoni

doi:10.1200/jco.2005.02.0826

Cited by 255 publications

(200 citation statements)

References 26 publications

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“…Eine kürzliche Cochrane Publikation [1256] schloss 3 weitere Studien in diese Metaanalyse ein [1255,1257,1258]. Es fand sich ein Überlebensvorteil für intensiver nachgesorgte Patienten nach 5 Jahren (OR 0,73; 95 % CI 0,59 -0,91), wobei aber die absolute Zahl an entdeckten Rezidiven in beiden Gruppen gleich war [30].…”

Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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“…However, the identification of local recurrence and metachronous (new) carcinoma also is an important aspect of follow-up; thus, endoscopy plays a central part in several surveillance guidelines. 4,6,7,25,26 Patients who are under observation may be referred for more extensive imaging, either because regular imaging forms part of the surveillance strategy or because tumor recurrence is suggested by the development of new symptoms, or a rise in tumor marker levels, most often the serial assessment of CEA. 10 Although evidence points toward a survival benefit for patients who undergo surveillance, the optimal protocol remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Consequently, heterogeneity is reported concerning compliance, effectiveness, costs, and survival benefits among studies. 4,[6][7][8][9] The only tumor marker in widespread clinical use for CRC surveillance is the carcinoembryonic antigen (CEA). The large number of tests required for serial serum measurement of CEA to detect 1 (asymptomatic) curable recurrence makes this test costly from an overall cost-benefit perspective.…”

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confidence: 99%

Microsatellite instability and DNA ploidy in colorectal cancer

Søreide

Slewa

Stokkeland

et al. 2009

Cancer

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BACKGROUND:Appropriate stratification tools for targeted surveillance after resection for colorectal cancer (CRC) are lacking. The objective of the current study was to investigate the effect of microsatellite instability (MSI) and DNA ploidy on surveillance after surgery.METHODS:The authors evaluated 186 consecutive, population‐based patients with stage I through III CRC who underwent surgery with curative intent and who entered a systematic surveillance program. MSI was analyzed with polymerase chain reaction for 5 known quasimonomorphic markers (BAT‐26, BAT‐25, NR‐21, NR‐24, and NR‐27), and DNA ploidy was analyzed with automated cytometry. Recurrence, recurrence‐free survival (RFS), and disease‐specific survival (DSS) were evaluated by univariate and multivariate statistical tests.RESULTS:Patients with MSI (20%) were significantly younger than patients without MSI (median age, 61 years vs 67 years; P = .016). Proximal location (adjusted odds ratio [AOR], 5.4; 95% confidence interval [95% CI], 2.1‐14.1 [P = .001]), large tumor size (≥5 cm: AOR, 3.5; 95% CI, 1.3–9.6 [P = .015]), and poor tumor differentiation (AOR, 6.6; 95% CI, 2–21.8 [P = .002]) were associated with MSI. MSI conveyed an increased risk for locoregional recurrence (OR, 2.9; 95% CI, 1.2–7 [P = .016]), with a trend toward a shorter time to recurrence (P = .060). Neither MSI status nor DNA ploidy predicted distant metastasis, RFS, or DSS. Lymph node status was the best predictor of distant spread (AOR, 3.9; 95% CI, 2–7.9 [P < .001]) and DSS (hazard ratio, 4.9; 95% CI, 2.6–9 [P < .001]).CONCLUSIONS:Patients who had microsatellite instable tumors were at increased risk for locoregional recurrence, whereas lymph node status was the best predictor of distant metastasis. Clinical surveillance and choice of modality (ie, endoscopy vs radiologic imaging) may be improved when patients are stratified according to these cancer features. Cancer 2009. © 2009 American Cancer Society.

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“…Treatment is based on curative surgical resection (R0). However, approximately half of the patients who undergo curative R0 surgery go on to develop recurrent disease, and the median survival time after the operation is no more than 2 years (Griffin et al, 1987;Rodriguez-Moranta et al, 2006). Adjuvant chemotherapy improves prognosis in these patients, but more than one-third of them still experience recurrence within the 2 years following curative therapy (Moertel et al, 1995;Mitry et al, 2005;Van Cutsem and Costa, 2005).…”

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confidence: 99%

“…The preferred treatment for patients with recurrent disease is resection of the metastases in the liver or lung, and this can result in a 5-year survival rate of 35 -40% (Scheele et al, 1990;Fong et al, 1997). This is why these patients should be followed-up using either clinical or biological exams, as well as imaging procedures (Desch et al, 2005;Rodriguez-Moranta et al, 2006;Sjovall et al, 2007).…”

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confidence: 99%

Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

et al. 2008

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We assessed the potential benefits of including systematic 18 fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting tumour recurrence in a prospective randomised trial. Patients (N ¼ 130) who had undergone curative therapy were randomised to undergo either conventional (Con) or FDG-PET procedures during follow-up. The two groups were matched at baseline. Recurrence was confirmed histologically. 'Intention-to-treat' analysis revealed a recurrence in 46 patients (25 in the FDG-PET group, and 21 in the Con group; P ¼ 0.50), whereas per protocol analysis revealed a recurrence in 44 out of 125 patients (23 and 21, respectively; P ¼ 0.60). In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers). Three false-positive cases of FDG-PET led to no beneficial procedures (two laparoscopies and one liver MRI that were normal). We failed to identify peritoneal carcinomatosis in two of the patients undergoing FDG-PET. The overall time in detecting a recurrence from the baseline was not significantly different in the two groups. However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P ¼ 0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0). Regular FDG-PET monitoring in the follow up of colorectal cancer patients may permit the earlier detection of recurrence, and influence therapy strategies.

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Postoperative Surveillance in Patients With Colorectal Cancer Who Have Undergone Curative Resection: A Prospective, Multicenter, Randomized, Controlled Trial

Abstract: A more intensive surveillance strategy improves the prognosis of patients with stage II colorectal cancer or those with rectal tumors. Inclusion of regular performance of colonoscopy seems justified up to the fifth year of follow-up, at least.

Cited by 255 publications

References 26 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

Microsatellite instability and DNA ploidy in colorectal cancer

Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

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