cancer, colorectal
DISEASE INTERVENTION COMPARISON RESULTS
PLoS One. 2011;6(6):e20456 Meta-Analysis
IN cancer, colorectal The Use of
high red meat and processed meat consumption
As Etiologic risk factor
Is useful Than
low red meat and processed meat consumption
To predict the risk of colorectal cancer : RR 1.22 for the highest versus the lowest intake, RR 1.14 for every 100 g/day increase in consumption
Lancet. 2010 Nov 20;376(9754):1741-50 Meta-Analysis
IN cancer, colorectal The Use of
aspirin dose, 75 mg daily or more, for more than 5 years
As Prevention, Primary
Is better Than
placebo
To reduce the 20-year risk of colon cancer incidence (HR 0.76) and mortality (HR 0.65), specially of proximal colon cancer.
N Engl J Med. 2003 Mar 6;348(10):883-90 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal The Use of
aspirin (325 mg daily)
As Prevention, Secondary
Is better Than
placebo
To prevent new colorectal adenomes in colonoscopy, at 12,8 months (17% in intv VS 27% in ctrl)
N Engl J Med. 2005 Dec 22;353(25):2654-66 Descriptive
IN cancer, colorectal The Use of
pathological signs of early metastatic invasion (venous emboli, lymphatic and perineural invasion)
As Prognostic Item
Is useful Than
no comparison
To predict survival: absence of early metastatic invasion was independently associated with increased survival. Tumours without early metastatic invasion had increased markers of T-cells migration, activation, and differentiation
Lancet. 1999 Jan 30;353(9150):345-50 Randomized Controlled Trial
IN cancer, colorectal The Use of
Immunotherapy, individualized tumor vaccine, after resection
As Treatment, Acute
Is better Than
no treatment
To reduce any cancer recurrence at 5 years: 19.5% vaccine VS 31.7% no-vaccine
N Engl J Med. 2004 Jun 3;350(23):2343-51 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal, adjuvant treatment The Use of
adjuvant chemotherapy after curative resection with oxiplatin added to fluorouracil plus leucovorin alone
As Treatment, Acute
Is better Than
adjuvant chemotherapy with fluorouracil plus leucovorin alone
To improve (moderately) the rate of disease-free survival at 3 years: 78.2% in intv. VS 72.9% in ctrl. No significative increase of adverse effects.
BMJ. 2006 Jul 8;333(7558):69-70. Epub 2006 Jun 21 Cohorts
IN cancer, colorectal, clinical presentation The Use of
new onset rectal bleeding in patients aged 45 or more
As Diagnostic Tool
Is useful Than
no comparison here
To investigate bowel: 5.7% of this patients had colorectal cancer, and 4.9% had colonic adenoma.
BMJ. 2002 Apr 6;324(7341):813 Meta-Analysis
IN cancer, colorectal, follow up after curative resection The Use of
intensive follow up, using frequent computed tomography (CT) and serum carcinoembryonic antigen (CEA)
As Prevention, Secondary
Is better Than
basic follow up
To reduce all cause mortality (absolute risk reduction about 7%), detect earlier all type of recurrences
Cochrane Database Syst Rev. 2002;(1):CD002200 Systematic Review, Cochrane Review
IN cancer, colorectal, follow up after curative resection The Use of
intensive follow up, using more test, including liver imaging
As Prevention, Secondary
Is better Than
basic follow up
To reduce all cause mortality at 5 years, detect earlier all type of recurrences. No useful data on quality of life, harms or cost-effectiveness were available
Arch Surg. 2005 Feb;140(2):183-9 Cohorts
IN cancer, colorectal, metastatic The Use of
prognostic factors: Dukes stage, number of metastases, carcino-embryonic antigen, alkaline phosphatase, and albumin
As Prognostic Item
Is good Than
-
To derive prognoses groups having different survival at 5 years: poor (0% survival), moderate (20% survival), good (62,5% survival)
N Engl J Med. 2004 Jun 3;350(23):2335-42 Randomized Controlled Trial, Multicenter Study, Clinical Trial, Phase III
IN cancer, colorectal, metastatic The Use of
monoclonal antibodies against vascular endothelial growth factor, bevacizumab, added to chemotherapy
As Treatment, Acute
Is better Than
chemotherapy alone (IFL: irinotecan, fluorouracil, and leucovorin in all cases)
To increase the rate of response (45% in intv VS 35% in ctrl) and median survival (20.3 months in intv. VS 15.6 months in ctrl.). Bevacizumab was associated with arterial hypertension (11%)
Lancet. 1997 Sep 6;350(9079):681-6 Randomized Controlled Trial
IN cancer, colorectal, metastatic The Use of
quimioterapia cronomodulada, fluorouracilo, oxiplatino
As Treatment, Acute
Is Than
To
Cancer. 1996 Oct 15;78(8):1639-45 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia regional hepática, vía arterial
As Treatment, Acute
Is Than
To
Lancet. 2000 Jul 29;356(9227):373-78 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia, fluorouracilo, infusión continua
As Treatment, Acute
Is Than
To
Lancet. 2002 May 4;359(9317):1555-63 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal, metastatic The Use of
quimioterapia, fluorouracilo, infusión continua, raltitrexed
As Treatment, Acute
Is Than
To
BMJ. 2000 Sept 2;321(7260):531-5 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia, quimioterapia regional hepática, fluorouracilo, irinotecan
As Treatment, Acute
Is Than
To
Health Technol Assess. 2001;5(25):1-128 Review, Academic
IN cancer, colorectal, metastatic The Use of
chemotherapy combining irinotecan or oxiplatin with fluorouracil and folinic acid
As Treatment, Acute, First-line
Is better Than
chemotherapy with fluorouracil and folinic acid alone
To extend both median progression-free and overall survival by a few (2-3) months.
Gastroenterology. 2004 Nov;127(5):1300-11 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is equal Than
conventional direct optical colonoscopy
To detect colorectal polypes: sensitivity 90%, specificity 92%, positive predictive value 88%, negative predictive value 93.5%, in per-patient analysis.
CMAJ. 2005 Oct 11;173(8):877-81 Randomized Controlled Trial
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is worse Than
conventional direct optical colonoscopy
To screening: A CT colonography based strategy plus colonoscopy if abnormalities is less cost-effective: more costly and slight more deaths due to missed adenomas.
N Engl J Med. 2007 Oct 4;357(14):1403-12 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is equal Than
conventional direct optical colonoscopy
To detect advanced colorectal cancer (3.2% scan VS 3.4% colonoscopy) whilst having much less need of colonoscopy (8%), having no perforation and removing much less polyps.
N Engl J Med. 2008 Sep 18;359(12):1207-17 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is good Than
conventional direct optical colonoscopy
To detect adenomas and cancers > 10 mm: 90% sensibility, 89% specificity
Am J Gastroenterol. 2008 Jun;103(6):1541-9 Systematic Review, Cochrane Review
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
fecal occult blood test (hemoccult)
As Diagnostic Tool
Is better Than
no screening
To slightly reduce death from colorectal cancer at 12-18 years (0.8% using hemoccult VS 1% no screening, NNT 617) while not reducing overall mortality (31%)
JAMA. 2004 Apr 14;291(14):1713-9 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Prevention, Primary
Is worse Than
conventional direct optical colonoscopy
To detect colorectal polypes: sensitivity of virtual colonoscopy for detecting patients with lesions >= 6 mm: 39% (conventional colonoscopy 99%) Computed tomographic colonography missed 2 of 8 cancers.
N Engl J Med. 2003 Dec 4;349(23):2191-2200 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Prevention, Primary
Is better Than
conventional direct optical colonoscopy
To Screening: Sensitivity of virtual colonoscopy was 93.8% for polyps at least 10 mm in diameter, 93.9 % for 8 mm and 88.7% for 6 mm. Specificity was 96.0% for polyps at least 10 mm, 92.2% for 8 mm, and 79.6% for 6 mm. 2 malignant polips were detected
Lancet. 2005 Jan 22-28;365(9456):305-11 Diagnostic
IN cancer, colorectal, screening in asymptomatic high risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is worse Than
conventional direct optical colonoscopy
To detect colorectal polyps > 6mm: virtual CT: sens. 55%, spec. 89%, +LR 5, -LR 0.51 ; coloscopy: sens. 99%, spec. 99.6%, +LR 248, -LR 0.01 ; barium enema: sens. 41%, spec. 82%, +LR 4.8, -LR 0.58.