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Meta-analysis of colorectal cancer follow-up after potentially curative resection

BACKGROUND: After potentially curative resection of primary colorectal cancer, patients may be monitored by measurement of carcinoembryonic antigen and/or CT to detect asymptomatic metastatic disease earlier. METHODS: A systematic review and meta-analysis was conducted to find evidence for the clini...

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Autores principales: Mokhles, S, Macbeth, F, Farewell, V, Fiorentino, F, Williams, N R, Younes, R N, Takkenberg, J J M, Treasure, T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031212/
https://www.ncbi.nlm.nih.gov/pubmed/27488593
http://dx.doi.org/10.1002/bjs.10233
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author Mokhles, S
Macbeth, F
Farewell, V
Fiorentino, F
Williams, N R
Younes, R N
Takkenberg, J J M
Treasure, T
author_facet Mokhles, S
Macbeth, F
Farewell, V
Fiorentino, F
Williams, N R
Younes, R N
Takkenberg, J J M
Treasure, T
author_sort Mokhles, S
collection PubMed
description BACKGROUND: After potentially curative resection of primary colorectal cancer, patients may be monitored by measurement of carcinoembryonic antigen and/or CT to detect asymptomatic metastatic disease earlier. METHODS: A systematic review and meta-analysis was conducted to find evidence for the clinical effectiveness of monitoring in advancing the diagnosis of recurrence and its effect on survival. MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science and other databases were searched for randomized comparisons of increased intensity monitoring compared with a contemporary standard policy after resection of primary colorectal cancer. RESULTS: There were 16 randomized comparisons, 11 with published survival data. More intensive monitoring advanced the diagnosis of recurrence by a median of 10 (i.q.r. 5–24) months. In ten of 11 studies the authors reported no demonstrable difference in overall survival. Seven RCTs, published from 1995 to 2016, randomly assigned 3325 patients to a monitoring protocol made more intensive by introducing new methods or increasing the frequency of existing follow-up protocols versus less invasive monitoring. No detectable difference in overall survival was associated with more intensive monitoring protocols (hazard ratio 0·98, 95 per cent c.i. 0·87 to 1·11). CONCLUSION: Based on pooled data from randomized trials published from 1995 to 2016, the anticipated survival benefit from surgical treatment resulting from earlier detection of metastases has not been achieved.
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spelling pubmed-50312122016-10-03 Meta-analysis of colorectal cancer follow-up after potentially curative resection Mokhles, S Macbeth, F Farewell, V Fiorentino, F Williams, N R Younes, R N Takkenberg, J J M Treasure, T Br J Surg Systematic Review BACKGROUND: After potentially curative resection of primary colorectal cancer, patients may be monitored by measurement of carcinoembryonic antigen and/or CT to detect asymptomatic metastatic disease earlier. METHODS: A systematic review and meta-analysis was conducted to find evidence for the clinical effectiveness of monitoring in advancing the diagnosis of recurrence and its effect on survival. MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science and other databases were searched for randomized comparisons of increased intensity monitoring compared with a contemporary standard policy after resection of primary colorectal cancer. RESULTS: There were 16 randomized comparisons, 11 with published survival data. More intensive monitoring advanced the diagnosis of recurrence by a median of 10 (i.q.r. 5–24) months. In ten of 11 studies the authors reported no demonstrable difference in overall survival. Seven RCTs, published from 1995 to 2016, randomly assigned 3325 patients to a monitoring protocol made more intensive by introducing new methods or increasing the frequency of existing follow-up protocols versus less invasive monitoring. No detectable difference in overall survival was associated with more intensive monitoring protocols (hazard ratio 0·98, 95 per cent c.i. 0·87 to 1·11). CONCLUSION: Based on pooled data from randomized trials published from 1995 to 2016, the anticipated survival benefit from surgical treatment resulting from earlier detection of metastases has not been achieved. Oxford University Press 2016-08-04 /pmc/articles/PMC5031212/ /pubmed/27488593 http://dx.doi.org/10.1002/bjs.10233 Text en © 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Systematic Review
Mokhles, S
Macbeth, F
Farewell, V
Fiorentino, F
Williams, N R
Younes, R N
Takkenberg, J J M
Treasure, T
Meta-analysis of colorectal cancer follow-up after potentially curative resection
title Meta-analysis of colorectal cancer follow-up after potentially curative resection
title_full Meta-analysis of colorectal cancer follow-up after potentially curative resection
title_fullStr Meta-analysis of colorectal cancer follow-up after potentially curative resection
title_full_unstemmed Meta-analysis of colorectal cancer follow-up after potentially curative resection
title_short Meta-analysis of colorectal cancer follow-up after potentially curative resection
title_sort meta-analysis of colorectal cancer follow-up after potentially curative resection
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031212/
https://www.ncbi.nlm.nih.gov/pubmed/27488593
http://dx.doi.org/10.1002/bjs.10233
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