Follow-up of gastric cancer: a review.
Follow-up of gastric cancer: a review.
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DOI：
10.1007/s10120-006-0360-0
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发表时间：
2006-01-01
期刊：
影响因子：
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通讯作者：
Sasako, Mitsuru
中科院分区：
文献类型：
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作者：
Whiting, John;Sano, Takeshi;Sasako, Mitsuru
虽然在胃癌的分期、分类和手术方面有广泛的共识，但关于胃切除术后的随访还没有达成共识。后续行动各不相同，从临床疑似复发的调查到早期发现复发的深入调查，前提是这可以提高生存率和生活质量。进展期胃癌的复发主要是局部复发或远处转移。内窥镜检查或计算机断层扫描（CT）发现的局部复发总是无法治愈的。对于早期胃癌，内窥镜检查可以发现新的原发灶，但这些肿瘤的发病率很低，需要成千上万的程序来检测每个可手术的病例。CT在检测肝转移方面要好得多，尽管这些转移通常是多发的且不可切除的，但有几份报告显示，孤立性转移的肝切除术后生存率良好。肿瘤标记物已成功用于检测亚临床复发，并可用于靶向更具侵入性或昂贵的手术。在化疗中，许多较新的药物有望显着改善生存率，但同样，缺乏证据表明，当患者出现症状之前给药时，其获益更大。总体而言，后续政策似乎既取决于机构的财富和设施，也取决于任何重要的证据基础。虽然复发性癌症的早期检测对患者和外科医生来说都是一个情绪化的问题，但考虑到随访投入的时间和金钱，以及缺乏有效性证据，需要进行密集随访的随机对照试验。
Although there is broad agreement in the staging, classification, and surgery for gastric cancer, there is no consensus regarding follow-up after gastrectomy. Follow-up varies from investigations on clinical suspicion of relapse to intensive investigations to detect recurrences early, assuming that this improves survival and quality of life. Advanced gastric cancers recur mainly by locoregional recurrence or distant metastasis. Local recurrences detected at endoscopy or on computed tomography (CT) are invariably incurable. For early gastric cancers, endoscopy can detect new primaries, but the incidence of these tumors is low, and many thousands of procedures are required to detect each operable case. CT is much better at detecting liver metastasis and, although these are usually multiple and unresectable, there are several reports of good survival following liver resection for isolated metastasis. Tumor markers have been used with some success to detect subclinical recurrences and could be used to target more invasive or expensive procedures. In chemotherapy, many newer agents are promising significantly improved survival, but again, the evidence for greater benefit when administered prior to the patient becoming symptomatic is lacking. Overall, it appears that follow-up policy is as much decided by the wealth and facilities of the institution as by any significant evidence base. Although the early detection of recurrent cancer is an emotive issue for both patients and surgeons, considering the amount of time and money invested in follow-up, and the lack of evidence of efficacy, a randomized controlled trial of intensive follow-up is required.