C J Verberne1, Z Zhan2, E van den Heuvel3, I Grossmann4, P M Doornbos5, K Havenga6, E Manusama7, J Klaase8, H C J van der Mijle9, B Lamme10, K Bosscha11, P Baas12, B van Ooijen13, G Nieuwenhuijzen14, A Marinelli15, E van der Zaag16, D Wasowicz17, G H de Bock18, T Wiggers19. 1. Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: c.j.verberne@umcg.nl. 2. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: z.zhan01@umcg.nl. 3. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: e.r.v.d.heuvel@tue.nl. 4. Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: irenegrossmann@me.com. 5. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. 6. Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. 7. Department of Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands. Electronic address: e.r.manusama@znb.nl. 8. Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. Electronic address: j.klaase@mst.nl. 9. Department of Surgery, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands. Electronic address: h.mijle@nijsmellinghe.nl. 10. Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands. Electronic address: b.lamme@asz.nl. 11. Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, Den Bosch, The Netherlands. Electronic address: k.bosscha@jbz.nl. 12. Department of Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands. Electronic address: p.c.baas@mzh.nl. 13. Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. Electronic address: b.van.ooijen@meandermc.nl. 14. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. Electronic address: grard.nieuwehuijzen@catharinaziekenhuis.nl. 15. Department of Surgery, Medical Center Haaglanden, Postbus 432, 2501 CK, Den Haag, The Netherlands. Electronic address: andreas.marinelli@mch.nl. 16. Department of Surgery, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. Electronic address: e.van.der.zaag@gelre.nl. 17. Department of Surgery, Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands. Electronic address: d.wasowicz@elisabeth.nl. 18. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: g.h.de.bock@umcg.nl. 19. Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: t.wiggers@umcg.nl.
Abstract
AIM: The value of frequent Carcino-Embryonic Antigen (CEA) measurements and CEA-triggered imaging for detecting recurrent disease in colorectal cancer (CRC) patients was investigated in search for an evidence-based follow-up protocol. METHODS: This is a randomized-controlled multicenter prospective study using a stepped-wedge cluster design. From October 2010 to October 2012, surgically treated non-metastasized CRC patients in follow-up were followed in eleven hospitals. Clusters of hospitals sequentially changed their usual follow-up care into an intensified follow-up schedule consisting of CEA measurements every two months, with imaging in case of two CEA rises. The primary outcome measures were the proportion of recurrences that could be treated with curative intent, recurrences with definitive curative treatment outcome, and the time to detection of recurrent disease. RESULTS:3223 patients were included; 243 recurrences were detected (7.5%). A higher proportion of recurrences was detected in the intervention protocol compared to the control protocol (OR = 1.80; 95%-CI: 1.33-2.50; p = 0.0004). The proportion of recurrences that could be treated with curative intent was higher in the intervention protocol (OR = 2.84; 95%-CI: 1.38-5.86; p = 0.0048) and the proportion of recurrences with definitive curative treatment outcome was also higher (OR = 3.12, 95%-CI: 1.25-6.02, p-value: 0.0145). The time to detection of recurrent disease was significantly shorter in the intensified follow-up protocol (HR = 1.45; 95%-CI: 1.08-1.95; p = 0.013). CONCLUSION: The CEAwatch protocol detects recurrent disease after colorectal cancer earlier, in a phase that a significantly higher proportion of recurrences can be treated with curative intent.
RCT Entities:
AIM: The value of frequent Carcino-Embryonic Antigen (CEA) measurements and CEA-triggered imaging for detecting recurrent disease in colorectal cancer (CRC) patients was investigated in search for an evidence-based follow-up protocol. METHODS: This is a randomized-controlled multicenter prospective study using a stepped-wedge cluster design. From October 2010 to October 2012, surgically treated non-metastasized CRCpatients in follow-up were followed in eleven hospitals. Clusters of hospitals sequentially changed their usual follow-up care into an intensified follow-up schedule consisting of CEA measurements every two months, with imaging in case of two CEA rises. The primary outcome measures were the proportion of recurrences that could be treated with curative intent, recurrences with definitive curative treatment outcome, and the time to detection of recurrent disease. RESULTS: 3223 patients were included; 243 recurrences were detected (7.5%). A higher proportion of recurrences was detected in the intervention protocol compared to the control protocol (OR = 1.80; 95%-CI: 1.33-2.50; p = 0.0004). The proportion of recurrences that could be treated with curative intent was higher in the intervention protocol (OR = 2.84; 95%-CI: 1.38-5.86; p = 0.0048) and the proportion of recurrences with definitive curative treatment outcome was also higher (OR = 3.12, 95%-CI: 1.25-6.02, p-value: 0.0145). The time to detection of recurrent disease was significantly shorter in the intensified follow-up protocol (HR = 1.45; 95%-CI: 1.08-1.95; p = 0.013). CONCLUSION: The CEAwatch protocol detects recurrent disease after colorectal cancer earlier, in a phase that a significantly higher proportion of recurrences can be treated with curative intent.
Authors: Rebecca A Snyder; Chung-Yuan Hu; Amanda Cuddy; Amanda B Francescatti; Jessica R Schumacher; Katherine Van Loon; Y Nancy You; Benjamin D Kozower; Caprice C Greenberg; Deborah Schrag; Alan Venook; Daniel McKellar; David P Winchester; George J Chang Journal: JAMA Date: 2018-05-22 Impact factor: 56.272
Authors: Eric P van der Stok; Manon C W Spaander; Dirk J Grünhagen; Cornelis Verhoef; Ernst J Kuipers Journal: Nat Rev Clin Oncol Date: 2016-12-20 Impact factor: 66.675
Authors: Matthew D Rutter; James East; Colin J Rees; Neil Cripps; James Docherty; Sunil Dolwani; Philip V Kaye; Kevin J Monahan; Marco R Novelli; Andrew Plumb; Brian P Saunders; Siwan Thomas-Gibson; Damian J M Tolan; Sophie Whyte; Stewart Bonnington; Alison Scope; Ruth Wong; Barbara Hibbert; John Marsh; Billie Moores; Amanda Cross; Linda Sharp Journal: Gut Date: 2019-11-27 Impact factor: 31.793
Authors: Brian D Nicholson; Bethany Shinkins; Indika Pathiraja; Nia W Roberts; Tim J James; Susan Mallett; Rafael Perera; John N Primrose; David Mant Journal: Cochrane Database Syst Rev Date: 2015-12-10
Authors: Beverley L Høeg; Pernille E Bidstrup; Randi V Karlsen; Anne Sofie Friberg; Vanna Albieri; Susanne O Dalton; Lena Saltbæk; Klaus Kaae Andersen; Trine Allerslev Horsboel; Christoffer Johansen Journal: Cochrane Database Syst Rev Date: 2019-11-21