Evaluation of an intensive strategy for follow-up and surveillance of primary breast cancer
Evaluation of an intensive strategy for follow-up and surveillance of primary breast cancer
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DOI：
10.1007/bf02303645
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发表时间：
1998-09-01
影响因子：
3.7
通讯作者：
Cox, CE
中科院分区：
文献类型：
--
作者：
Joseph, E;Hyacinthe, M;Cox, CE
背景：关于乳腺癌患者随访护理的频率和强度存在争议。一些内科医生采用强化随访的方法，包括频繁的实验室检查和常规影像检查，包括胸部X线片、骨骼扫描和CT扫描，而另一些医生则建立了只包括病史、体检和乳房X光检查的最低限度的方法。目的：我们的目标是评估强化随访在乳腺癌复发检测中的作用，并检查随访对总生存率的影响。方法：在10年期间(1986-1996)，从1898名乳腺癌患者的前瞻性数据库中确定129名复发患者。结果：126例患者中，27例(21%)分为强化检测组(LFT、CEA、CA15-3、胸片、CT、骨扫描)，99例(79%)分为最小检测组(病史、体格检查、钼靶摄影)。最常见的初始肿瘤复发是骨骼远处的疾病，占27%。病史、体格检查和乳房X光检查发现复发癌症的时间与LFT、肿瘤标志物、CT扫描和胸部X光检查大致相同(P=.960)。将复发患者分为强化组和简化组，按发现复发的时间进行分析，强化法和简化法检测复发的时间差异无统计学意义(P=.95)。采用Cox比例风险模型对年龄、肿瘤大小、手术类型、阳性结节数、复发时间、检测方法、复发部位(区域或远处)进行单因素和多因素分析。经多因素分析，只有两个变量对生存率有影响：复发的早期时间(P=.0011)和复发的地点(P=.02)。时间被定义为早(从诊断到复发的时间小于或等于365天)或晚(从诊断到复发的时间大于或等于365天)。在逐步前向回归分析中，早期复发是第一个有意义的变量。在第二步，复发的主要部位是重要的。检测方法--强化或最小--对生存率没有显著影响(P=.18)。结论：常规强化随访方案在检测复发乳腺癌方面没有生存益处。昂贵的诊断测试，如骨扫描、CT扫描和系列肿瘤标志物，最适合用于检测有症状的患者的转移。
Background: Controversies over the frequency and intensity of the follow-up care of breast cancer patients exist. Some physicians have adopted an intensive approach to follow-up care that consists of frequent laboratory tests and routine imaging studies, including chest radiographs, bone scans, and CT scans, whereas others have established a minimalist approach consisting of only history, physical examinations, and mammograms.Objectives: Our objective was to evaluate the role of intensive follow-up on detection of breast cancer recurrence and to examine the impact of follow-up on overall survival.Methods: During a 10-year period (1986-1996), 129 patients with recurrent disease were identified from a prospective database of 1898 breast cancer patients. The patients with recurrent disease were divided into minimalist or intensive groups according to method of detection.Results: Twenty-seven of 126 (21%) patients were assigned to the intensive method of detection group (LFT, CEA, CA 15-3, chest radiograph, CT scan, and bone scan); 99 of 126 (79%) patients were assigned to the minimal detection group (history, physical examination, and mammography). Distant disease to the bone was the most common initial tumor recurrence, at 27%. History, physical examination, and mammography detected recurrent cancer in approximately the same amount of time as LFTs, tumor markers, CT scans, and chest radiographs (P = .960). When the recurrent patients were divided into intensive and minimalist groups and analyzed by time to detection of recurrence, there was no significant difference between the time to detection in those recurrences detected by intensive methods and those recurrences detected by minimalist methods (P = .95).The independent variables age, tumor size, type of surgery, number of positive nodes, time to recurrence, method of detection, and site of recurrence (regional or distant) were subject to univariate and multivariate analysis by the Cox proportional hazards model. Only two variables had an impact on survival by multivariate analysis: early timing of the recurrence (P = .0011) and the site of the recurrence (P = .02). Timing was defined as early (less than or equal to 365 days from the time of diagnosis to recurrence) or late (greater than or equal to 365 days from the time of diagnosis to recurrence). Early recurrence was the first variable found to be significant on stepwise forward regression analysis. The primary site of recurrence was significant at step two. The method of detection-intensive or minimal-did not significantly affect survival (P = .18).Conclusions: There is no survival benefit to routine intensive follow-up regimens in detecting recurrent breast cancer. Expensive diagnostic tests such as bone scans, CT scans, and serial tumor markers are best used for detection of metastasis in symptomatic patients.