The haphazard approach to the early detection of asymptomatic renal cancer: results from a contemporary executive health programme
The haphazard approach to the early detection of asymptomatic renal cancer: results from a contemporary executive health programme
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DOI：
10.1111/j.1464-410x.2008.08315.x
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发表时间：
2009-07-01
影响因子：
4.5
通讯作者：
Castle, Erik P.
中科院分区：
文献类型：
--
作者：
Feldstein, Murray S.;Rhodes, Deborah J.;Castle, Erik P.
目的比较传统筛查方法(病史、体检和尿液分析)与肾脏影像筛查的无症状性肾细胞癌(RCC)的检出情况。方法和方法我们回顾了2002年1月1日至2007年9月30日在梅奥诊所接受行政体检的患者的病例记录。结果在32 310例患者中，18例RCC被发现；其中13例(72%)被EHP发现，5例(28%)在最初的EHP筛查过程中被遗漏，但后来在4-24个月内被发现。在通过EHP检测到的13例中，有8例是偶然发现的，2例是由于症状，3例是由于无症状镜检血尿(AMH)。在13例中，12例被归类为早期癌症(I期)。相比之下，在EHP筛查过程中遗漏的五种癌症中，有两种是由于症状的发展而被诊断出来的，只有一种被归类为I期癌症。到目前为止，EHP没有发现癌症的这些患者中，有两人发生了转移，其中一人已经死亡。两者都在EHP中进行了多年的随访，在多个标本中都没有MH。结论EHP遵循标准政策，依靠病史、体格检查和尿液分析来决定评估谁是无症状的RCC。这种做法漏掉了70%的潜在可诊断癌症。EHP最初发现的肾癌患者的情况比那些被推迟诊断的患者要好。我们每10 000人中就有4人被发现，这只是使用成像作为筛查工具的方案所报告的一小部分。我们目前早期发现无症状肾细胞癌的方法背后的逻辑需要重新评估。AMH在大多数情况下是巧合的，如果患者不适合进行筛查，他们可能会放弃成像。然而，AMH将错过大多数可治疗的癌症，不是早期发现计划的适当筛查测试。在缺乏可靠的生物标志物的情况下，肾脏成像应该是早期检测计划中知情的、临床上合适的人检测无症状肾细胞癌的主要筛查工具。
OBJECTIVETo compare the detection of asymptomatic renal cell carcinoma (RCC) in an executive health programme (EHP) that uses traditional methods of screening (history, physical examination and urine analysis) to programmes that screen by renal imaging.PATIENTS AND METHODSWe retrospectively reviewed case records from patients undergoing executive health examinations at Mayo Clinic between 1 January 2002 and 30 September 2007.RESULTSOf 32 310 patients, 18 RCCs were detected; of these, 13 (72%) were detected by the EHP and five (28%) were missed by the initial EHP screening process but subsequently discovered within 4-24 months. Of the 13 detected through the EHP, eight were discovered incidentally, two because of symptoms, and three because of asymptomatic microscopic haematuria (AMH). Of the 13, 12 were classified as early-stage cancers (Stage I). By contrast, of the five cancers missed by the EHP screening process, two were diagnosed because of the development of symptoms and only one was classified as Stage I. To date, two of these patients whose cancers were undetected by the EHP developed metastasis and one of them has died. Both had been followed in the EHP for years and neither had MH in multiple specimens.CONCLUSIONOur EHP follows standard policy and relies on a history, physical examination and urine analysis to decide who to evaluate for asymptomatic RCC. This practice missed > 70% of the potentially diagnosable cancers. The patients with RCCs that were discovered initially by the EHP fared better than those whose diagnosis was delayed. Our detection rate of four per 10 000 was only a fraction of those reported by programmes using imaging as a screening tool. The logic behind our current approach to the early detection of asymptomatic RCC needs to be reassessed. AMH is coincidental in most cases and patients could forego imaging if they are unsuitable candidates for screening. However, AMH will miss most treatable cancers and is not an appropriate screening test for an early detection programme. In the absence of reliable biomarkers, renal imaging should be the primary screening tool for detecting asymptomatic RCC in informed, clinically suitable individuals enrolled in an early detection programme.