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    • A Systematic Review Comparing Surveillance Recommendations for the Detection of Recurrence Following Surgery Across 16 Common Cancer Types

    BMJ oncology（2025）

    Department of Public Health and Primary Care | School of Clinical Medicine | Department of Oncology | Department of Surgery | Independent Researcher. | Department of Urology | Department of Thoracic Oncology | Hepato-Pancreato-Bilary Surgery | Precision Breast Cancer Institute

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    Abstract
    Objectives Identify and compare guidelines making recommendations for surveillance to detect recurrence in 16 common solid cancers after initial curative treatment in asymptomatic patients.Methods and analysis We conducted a systematic review, combining search results from two electronic databases, one guideline organisation website (NICE), expert consultation and manual searching. Screening and data extraction were carried out by multiple reviewers. We collected data from each guideline on recommendations for surveillance and the use of risk stratification. Findings were compared between cancer types and regions. Text mining was used to extract statements on the evidence for surveillance. A protocol was published on PROSPERO in 2021 (CRD42021289625).Results We identified 123 guidelines across 16 cancer types. Almost all guidelines (n=115, 93.5%) recommend routine surveillance for recurrent disease in asymptomatic patients after initial treatment. Around half (n=59, 51.3%) recommend indefinite or lifelong surveillance. The most common modality of surveillance was cross-sectional imaging. Risk stratification of frequency, length and mode of surveillance was widespread, with most guidelines (n=92, 74.8%) recommending that surveillance be adapted based on patient risk. More than a third (n=50, 39.0%) gave incomplete or vague recommendations. For 14 cancers, we found statements indicating there is no evidence that surveillance improves survival.Conclusion Although specific details of follow-up schedules vary, common challenges were identified across cancer types. These include heterogenous recommendations, vague or non-specific guidance and a lack of cited evidence supporting the use of surveillance to improve outcomes. Evidence generation in this area is challenging; however, increased availability to linked health records may provide a way forward.PROSPERO registration number CRD42021289625.
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    【要点】：本研究通过系统综述比较了16种常见癌症类型术后复发监测的推荐指南，发现监测指南存在异质性、不明确及缺乏支持证据的问题，并提出增加健康记录链接的可用性可能为未来研究提供方向。
    

    【方法】：研究采用系统综述方法，结合两个电子数据库、一个指南组织网站（NICE）、专家咨询和手动搜索的结果，对16种癌症类型的监测指南进行筛选和数据提取。
    

    【实验】：研究共识别了123项指南，涉及16种癌症类型，发现93.5%的指南推荐对无症状患者进行术后常规监测，51.3%的指南推荐无限期或终身监测，监测方式以横断面成像最为常见，74.8%的指南推荐根据患者风险调整监测频率、时长和方式，但超过三分之一（39.0%）的指南给出的推荐不完整或模糊。对于14种癌症，指南表明没有证据显示监测能提高生存率。数据集名称未在文中明确提及。