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

Jeffery, G.Mark; Hickey, Brigid E; Hider, Phil

doi:10.1002/14651858.cd002200

Cited by 213 publications

(217 citation statements)

References 39 publications

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“…Mortality rates have not decreased significantly in recent decades, despite advances in diagnosing CRC and its metastases and improved surgical techniques and postoperative care. New monitoring strategies, such as magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT), have been proposed; however, carcinoembryonic antigen (CEA) remains the most common tumour marker for CRC monitoring, especially after tumour resection with curative intent (4,9) . Although it is important as an independent prognostic variable and in postoperative monitoring, serum CEA collected from peripheral blood may be…”

Section: Introductionmentioning

confidence: 99%

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Rezende

Palma

Toloi

et al. 2013

Arq. Gastroenterol.

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ContextThe serum carcinoembryonic antigen (CEA) is an important prognostic factor in colorectal cancer, however the rectum presents different routes of venous drainage, stating that the level of CEA in peripheral and mesenteric rectal tumors may be different, depending on the location of the tumor in the rectal segment.ObjectiveThe goal of this study was to evaluate the relationship between the peripheral and mesenteric venous levels of CEA and the association between these levels and the tumour location in the rectums of patients successfully operated on for rectal carcinoma.MethodsThirty-two patients who were surgically treated for rectal carcinoma were divided into patients with tumours located in the upper rectum (n = 11) or lower rectum (n = 21). The CEA values were assessed by electrochemiluminescence immunoassay. Serum and mesenteric CEA levels were associated with the tumour anatomopathological characteristics: location, histological type, cellular differentiation grade, depth of invasion into the rectal wall, angiolymphatic invasion, tumour, node, and metastasis staging; and the CEA index (≤1.0 or ≥1.0 ng /mL).ResultsAnalysis of the serum CEA values using clinical and anatomopathological parameters revealed no significant association with tumour location, histological type, cellular differentiation grade, depth of invasion into the intestinal wall, and tumour, node, and metastasis staging. The mesenteric CEA levels were significantly associated with the tumour location (P = 0.01). The CEA values in the mesenteric venous blood and the presence of angiolymphatic invasion (P = 0.047) were significantly different. A significant relationship was found between the CEA index value and the rectal tumour location (P = 0.0001).ConclusionsThe CEA levels were higher in the mesenteric vein in tumours located in the upper rectum and in the presence of angiolymphatic invasion. CEA drainage from lower rectum adenocarcinomas preferentially occurs through the systemic pathway.

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Section: Introductionmentioning

confidence: 99%

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Rezende

Palma

Toloi

et al. 2013

Arq. Gastroenterol.

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“…The merits of early detection and treatment of recurrent disease have been vigorously debated. Recently, the present authors and a Cochrane review group independently reported two meta-analyses of all randomised trials of follow up strategies for patients treated for colorectal cancer and showed a significant improvement in all cause mortality in patients followed intensively 5 6. A further randomised trial has since been published supporting these findings 7.…”

Section: Introductionmentioning

confidence: 58%

“…Previous studies have examined economic issues related to follow up after treatment for colorectal cancer,28 – 33 but predated the effectiveness data provided by the two recently published meta-analyses 5 6. The present analysis is strengthened by the inclusion of a comprehensive search to include many aspects of cost estimates (a “bottom-up” approach) and sensitivity analyses at several levels.…”

Section: Discussionmentioning

confidence: 99%

Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer

Renehan

2004

BMJ

102

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Objective To determine the cost effectiveness of intensive follow up compared with conventional follow up in patients with colorectal cancer. Design Incremental cost effectiveness analysis recognising differences in follow up strategies, based on effectiveness data from a meta-analysis of five randomised trials. Setting United Kingdom. Main outcome measures Taking a health service perspective, estimated incremental costs effectiveness ratios for each life year gained for five trials and four trials designed for early detection of extramural recurrences (targeted surveillance). Results Based on five year follow up, the numbers of life years gained by intensive follow up were 0.73 for the five trial model and 0.82 for the four trial model. For the five trials, the adjusted net (extra) cost for each patient was £2479 (€3550; $4288) and for each life year gained was £3402, substantially lower than the current threshold of NHS cost acceptability (£30 000). The corresponding values for the four trial model were £2529 and £3077, suggesting that targeted surveillance is more cost effective. The main predictor of incremental cost effectiveness ratios was surveillance costs rather than treatment costs. Judged against the NHS threshold of cost acceptability, the predicted incremental cost threshold was ninefold and the effectiveness threshold was 3%. Conclusions Based on the available data and current costs, intensive follow up after curative resection for colorectal cancer is economically justified and should be normal practice. There is a continuing need to evaluate the efficacy of specific surveillance tools: this study forms the basis for economic evaluations in such trials.

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“…Two meta-analyses of five randomised trials identified a survival advantage for the patients followed more intensely as significantly higher incidence of asymptomatic local or systemic recurrence was recognized among the patients monitored closely and, consequentially, reoperation for cure was more frequent in this group 24,25. These results were confirmed by another, recently published meta-analysis including six randomised trials on this topic with a significant improvement in survival favouring more intense follow-up (Relative Risk Ratio 0.80; 95% CI, 0.70 to 0.91; p = 0.0008).…”

Section: Studies Of Crc Follow-up Strategiesmentioning

confidence: 99%

Post-treatment surveillance in colorectal cancer

Velenik

2010

Radiology and Oncology

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BackgroundThough the post treatment surveillance of patients with colorectal cancer (CRC) treated with curative intent is common practice, its value is controversial. In the absence of conclusive clinical data, various modalities for the routine follow-up of patients with CRC have been proposed. In practice, the guidelines across countries and regions differ and are influenced by different health care policies, resource availability and doubts about effectiveness of follow-up.ConclusionsThe results of metaanalyses of available clinical trials demonstrated a survival benefit of intensified monitoring, but the questions regarding the optimal frequency of visits and the examinations to be performed remain unanswered. Furthermore, intensive monitoring of CRC survivors may be difficult to be administrated, causes discomfort and morbidity to the patient and can have serious cost-implications to the healthcare system. However, as it seems from available data, a comprehensive surveillance program does not affect the quality of patients’ life. Ongoing large prospective multi-institutional randomised trials might elucidate some of the crucial questions and existing dilemmas to establish adequate surveillance strategy for CRC patients.

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

Cited by 213 publications

References 39 publications

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer

Post-treatment surveillance in colorectal cancer

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