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目的:回顾大肠癌患者根治术后随诊的临床试验证据。 设计:对加强随诊与对照进行比较的随机对照临床试验进行系统性综述和汇总分析(Meta-analysis)。 主要结局的判定指标:所有原因的5年死亡率(主要结果);粘膜内复发、局部复发、转移和非同时癌(第二原发大肠癌)的发生率(次要结果)。 结果:5组临床试验包括1342例符合纳入标准的病人。加强随诊与所有原因死亡率的减少有关(联合风险比0.81,95％可信区间0.70～0.94,P=0.007)。这种影响在用计算机断层扫描(CT)和经常的血清癌胚抗原检测(CEA)的4组粘膜外检查试验中最为明显。加强随诊可显著地提前发现所有复发(平均差距8.5月,7.6～9.4月,P<0.001),并且增加孤立的局部复发的发现率(风险比1.61,1.12～2.32,P=0.011)。 结论;大肠癌根治术后加强随诊可改善生存。对于确定加强随诊中哪一部分最有价值,需要进一步扩大的临床研究。
Objective: To review evidence of clinical trial of patients with colorectal cancer after radical operation. DESIGN: A systematic review and meta-analysis of randomized controlled clinical trials comparing enhanced follow-up with controls. Criteria for determining primary outcomes: 5-year mortality (primary outcome) for all causes; incidence of mucosal recurrence, local recurrence, metastasis, and non-concurrent cancer (secondary primary colorectal cancer) (secondary outcome). Results: Five groups of clinical trials included 1342 eligible patients. Intensive follow-up was associated with a reduction in all-cause mortality (combined risk 0.81, 95% confidence interval 0.70-0.94, P = 0.007). This effect is most pronounced in the four sets of mucosal examinations using computed tomography (CT) and frequent serum carcinoembryonic antigen (CEA) tests. All follow-ups were significantly improved with early detection of all recurrences (mean, 8.5, 7.6 to 9.4 months, P <.001) and increased rates of isolated local recurrence (hazard ratio 1.61, 1.12-2.32, P = 0.011). Conclusions: Follow-up after radical operation of colorectal cancer can improve survival. There is a need for further clinical studies to determine which part of the follow-up is most valuable.