Is follow-up of lung cancer patients after resection medically indicated and cost-effective?
Is follow-up of lung cancer patients after resection medically indicated and cost-effective?
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DOI：
10.1016/0003-4975(95)00893-4
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发表时间：
1995-12-01
影响因子：
4.6
通讯作者：
Roth, JA
中科院分区：
文献类型：
--
作者：
Walsh, GL;OConnor, M;Roth, JA
背景目前还没有关于肺癌患者肺切除术后适当随访的指南。1987年至1991年间，连续358例非小细胞肺癌患者接受了完全切除术，对肿瘤复发和第二原发肿瘤的发展进行了评价。复发按部位（局部或远处）、表现方式（有症状或无症状）、治疗（治愈或姑息）和总生存期进行分类。135例患者复发（仅局部，32例;局部和远处，13例;仅远处，90例）。其中，102例有症状，33例无症状（大多数通过筛查胸部X线片诊断）。40例患者接受了根治性治疗（手术或放射治疗> 50戈伊），95例患者接受了姑息性治疗。有症状患者复发后的中位生存期为8.0个月，无症状患者为16.6个月（p = 0.008）。多变量分析显示，无病期（大于12个月或小于等于12个月）是预测复发后生存率的最重要变量，而表现方式、复发部位、初始阶段和组织学类型对生存率无显著影响。35例患者发生新的原发肿瘤。虽然无症状复发的检测提供了8至10个月的提前时间偏差，治疗模式和总生存期并没有受到这种早期检测的很大影响。无病期似乎是生存的最重要决定因素。对肺癌患者进行无症状复发的筛查不太可能有效。肺癌术后患者的频繁随访和广泛的放射学评估可能是不必要的。
Background. There are no guidelines for the appropriate follow-up of patients after pulmonary resection for lung cancer.Methods. Three-hundred fifty-eight consecutive patients who had undergone complete resections of nonsmall cell lung cancer between 1987 and 1991 were evaluated for tumor recurrence and development of second primary tumors. Recurrences were categorized by site (local or distant), mode of presentation (symptomatic or asymptomatic), treatment given (curative intent or palliative), and duration of overall survival.Results. Recurrences developed in 135 patients (local only, 32; local and distant, 13; and distant only, 90). Of these, 102 were symptomatic and 33 were asymptomatic (most diagnosed by screening chest roentgenogram). Forty patients received treatment with curative intent (operation or radiation therapy > 50 Gy) and 95 were treated palliatively. The median survival duration from time of recurrence was 8.0 months for symptomatic patients and 16.6 months for asymptomatic patients (p = 0.008). Multivariate analysis shows that disease-free interval (greater than 12 months or less than or equal to 12 months) was the most important variable in predicting survival after recurrence and that mode of presentation, site of recurrence, initial stage, and histologic type did not significantly affect survival. New primary tumors developed in 35 patients.Conclusions. Although detection of asymptomatic recurrences gives a lead time bias of 8 to 10 months, mode of treatment and overall survival duration are not greatly affected by this earlier detection. Disease-free interval appears to be the most important determinant of survival. Screening for asymptomatic recurrences in patients who have had lung cancer is unlikely to be cast-effective. Frequent follow-up and extensive radiologic evaluation of patients after operation for lung cancer are probably unnecessary.