Additional evidence of no increased survival benefit to intensive follow-up after colorectal cancer surgery

Référence

Wille-Jorgensen P, Syk I, Smedh K, et al, for the COLOFOL Study Group. Effect of more vs less frequent follow-up testing on overall and colorectal cancer-specific mortality in patients with stage II or III colorectal cancer. The COLOFOL randomized clinical trial. JAMA 2018;319(20):2095-2103.

Sommaire

A previous study in this same journal reported that intensive follow-up compared with minimal follow-up after curative surgery for colorectal cancer resulted in more patients undergoing repeat surgery but no reduction in overall mortality or disease-specific mortality (Primrose JN, et al. JAMA 2014;311(3):263-70). In a similar study, these investigators enrolled adults, 75 years or younger, after surgical resection with curative intent with stage II or III colorectal cancer. After either a normal CEA test or negative diagnostic work-up 1 month after surgery, 2555 patients randomly received assignment (concealed allocation) to a high-frequency follow-up group (computed tomography [CT] scan of thorax and abdomen and carcinoembryonic antigen [CEA] testing at 6, 12, 18, 24, and 36 months after surgery) or a low-frequency follow-up group (CT scan of thorax and abdomen and CEA testing at 12 and 36 months after surgery). Complete follow-up occurred for 99.9% of patients at 5 years. Using both intention-to-treat and per-protocol analysis, there were no significant group differences in all-cause or cancer-specific mortality rates. There were also no group differences in outcomes according to cancer stage or location (including both colon and rectal sites). A third study in the same journal issue (Snyder RA, et al. JAMA 2018;319(20):2104-15) also found no significant association between intensity of follow-up and detection of recurrence or overall survival.