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Original Investigation
May 22/29, 2018

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Author Affiliations
  • Mens Heel Walking On Khaki Mid Up Spot Lace Boots 1Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
  • 2Department of Surgery, University of South Carolina School of Medicine, Greenville
  • 3American College of Surgeons (ACS) Cancer Programs, Chicago, Illinois
  • 4Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
  • 5Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
  • 6Department of Surgery, Washington University, St Louis, Missouri
  • 7Division of Population Sciences, Dana Farber Cancer Institute, Boston, Massachusetts
  • 8Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
  • 9Department of Surgery, Wright State University, Dayton, Ohio
  • 10Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston
JAMA. 2018;319(20):2104-2115. doi:10.1001/jama.2018.5816
Key Points
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Question  Is there an association between intensity of posttreatment surveillance for stage I, II, or III colorectal cancer and time to detection of cancer recurrence?

Findings  In this retrospective cohort study that included 8529 patients with stage I, II, or III colorectal cancer, the median time to recurrence for patients in the high-intensity imaging surveillance group was 15.1 months vs 16.0 months in the low-intensity group and for patients in the high-intensity carcinoembryonic antigen surveillance group was 15.9 months vs 15.3 months in the low-intensity group. Neither difference was statistically significant.

Meaning  There was no significant association between intensity of surveillance and time to detection of colorectal cancer recurrence.

Abstract

Importance  Surveillance testing is performed after primary treatment for colorectal cancer (CRC), but it is unclear if the intensity of testing decreases time to detection of recurrence or affects patient survival.

Objective  To determine if intensity of posttreatment surveillance is associated with time to detection of CRC recurrence, rate of recurrence, resection for recurrence, or overall survival.

Design, Setting, and Participants  A retrospective cohort study of patient data abstracted from the medical record as part of a Commission on Cancer Special Study merged with records from the National Cancer Database. A random sample of patients (n=8529) diagnosed with stage I, II, or III CRC treated at a Commission on Cancer–accredited facilities (2006-2007) with follow-up through December 31, 2014.

Exposures  Intensity of imaging and carcinoembryonic antigen (CEA) surveillance testing derived empirically at the facility level using the observed to expected ratio for surveillance testing during a 3-year observation period.

Main Outcomes and Measures  The primary outcome was time to detection of CRC recurrence; secondary outcomes included rates of resection for recurrent disease and overall survival.

Heel Mens Spot Lace Up Walking Khaki Boots On Mid Results  A total of 8529 patients (49% men; median age, 67 years) at 1175 facilities underwent surveillance imaging and CEA testing within 3 years after their initial CRC treatment. The cohort was distributed by stage as follows: stage I, 25.0%; stage II, 35.2%; and stage III, 39.8%. Patients treated at high-intensity facilities—4188 patients (49.1%) for imaging and 4136 (48.5%) for CEA testing—underwent a mean of 2.9 (95% CI, 2.8-2.9) imaging scans and a mean of 4.3 (95% CI, 4.2-4.4) CEA tests. Patients treated at low-intensity facilities—4341 patients (50.8%) for imaging and 4393 (51.5%) for CEA testing—underwent a mean of 1.6 (95% CI, 1.6-1.7) imaging scans and a mean of 1.6 (95% CI, 1.6-1.7) CEA tests. Imaging and CEA surveillance intensity were not associated with a significant difference in time to detection of cancer recurrence. The median time to detection of recurrence was 15.1 months (IQR, 8.2-26.3) for patients treated at facilities with high-intensity imaging surveillance and 16.0 months (IQR, 7.9-27.2) with low-intensity imaging surveillance (difference, −0.95 months; 95% CI, −2.59 to 0.68; HR, 0.99; 95% CI, 0.90-1.09) and was 15.9 months (IQR, 8.5-27.5) for patients treated at facilities with high-intensity CEA testing and 15.3 months (IQR, 7.9-25.7) with low-intensity CEA testing (difference, 0.59 months; 95% CI, −1.33 to 2.51; HR, 1.00; 95% CI, 0.90-1.11). No significant difference existed in rates of resection for cancer recurrence (HR for imaging, 1.22; 95% CI, 0.99-1.51 and HR for CEA testing, 1.12; 95% CI, 0.91-1.39) or overall survival (HR for imaging, 1.01; 95% CI, 0.94-1.08 and HR for CEA testing, 0.96; 95% CI, 0.89-1.03) among patients treated at facilities with high- vs low-intensity imaging or CEA testing surveillance.

Conclusions and Relevance  Among patients treated for stage I, II, or III CRC, there was no significant association between surveillance intensity and detection of recurrence.

Trial Registration  clinicaltrials.gov Identifier: NCT02217865

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