More frequent follow-up after curative surgery did not significantly reduce 10-year mortality rates in patients with stage II and stage III colorectal cancer.

More frequent follow-up after curative surgery did not significantly reduce 10-year mortality rates in patients with stage II and stage III colorectal cancer, according to a study published online in JAMA Network Open.

The finding stemmed from a posttrial prespecified secondary analysis of the COLOFOL randomized clinical trial. The original study investigated 5-year mortality rates with high- versus low-frequency follow-up.

“Our findings extend data from the initial trial, which did not reveal a significant reduction in 5-year overall or colorectal cancer-specific mortality,” reported corresponding author Henrik Toft Sørensen, MD, PhD, DMSc, DSc, and study coauthors.

Study Parameters & Results

The secondary analysis, with an extended decade-long follow-up, included 2456 patients with stage II or III colorectal cancer in Sweden and Denmark. Researchers used population-based health registries to investigate 10-year survival outcomes for 1227 patients who received follow-up testing with computed tomography (CT) scans and serum carcinoembryonic antigen (CEA) screening on 5 occasions (at 6, 12, 18, 24, and 36 months after surgery) and compared them with outcomes for 1229 patients who received the same follow-up testing but on just 2 occasions (at 12 and 36 months after surgery).

“We hypothesized that high-frequency follow-up screening with CT scan and CEA screening with a focus on the participants who had potentially been treated for recurrence would decrease the 10-year overall and colorectal cancer-specific mortality after curative surgery,” researchers wrote.

The extended analysis, however, identified no significant decrease in mortality with more intensive follow-up screening. According to the study, patients who received high-frequency screening had a 10-year overall mortality rate of 27.1%. In patients with low-frequency screening, overall mortality was 28.4%. The difference in risk was 1.3%.

Colorectal cancer-specific mortality, meanwhile, was 15.6% at 10 years for the high-frequency group compared with 16.0% for the low-frequency group. The risk difference in colorectal cancer-specific mortality was 0.4% between the groups.

“The low-frequency follow-up regimen used in our trial is less intense than recommended in the guidelines provided by the National Comprehensive Cancer Network and the American Society of Clinical Oncology,” researchers wrote.

They advised that the study’s findings should be considered evidence for updating existing clinical guidelines.