Cooper G S, Yuan Z, Chak A, Rimm A A
Department of Epidemiology and Biostatistics, Case Western Reserve University, University Hospitals of Cleveland, Ohio 44106, USA.
Cancer. 1999 May 15;85(10):2124-31.
There are a paucity of data supporting the routine use of follow-up testing to detect recurrent disease after potentially curative initial surgery in patients with nonmetastatic colorectal carcinoma.
Using the population-based Surveillance, Epidemiology, and End Results (SEER) registry, all patients age > or =65 years with local or regional colorectal carcinoma who were diagnosed in 1991, underwent surgical resection, and survived at least 6 months after diagnosis were identified. All inpatient, hospital outpatient, and physician/supplier Medicare claims from 6 months after diagnosis through 1994 were examined for follow-up procedures of interest. Procedure use during follow-up was compared across patient groups using both bivariate and multivariate analyses.
A total of 5716 patients were identified, with 1.3% found to have developed subsequent primary tumors of the colon or rectum, and 74% surviving through 1994. One or more procedures of interest were performed in 88% of patients; the most commonly performed tests were liver enzymes, chest X-rays, colonoscopy, and computed tomography scans. Lower rates of testing generally were observed with older age groups, patients with fewer comorbidities, and patients who did not survive through the follow-up period. Among all procedures studied, there also was significant variation in the rates of testing across the 9 SEER areas, varying from 1.5-fold to 3.6-fold. The geographic variation persisted in multivariate models adjusting for potentially confounding factors.
The current study found significant variability in the use of follow-up procedures, with the most striking differences apparent across geographic regions. Further studies are needed to determine the underlying reasons for the disparities, as well as the impact of surveillance on patient outcomes.
对于非转移性结直肠癌患者，在进行了可能治愈性的初始手术后，缺乏支持常规使用随访检测来发现复发性疾病的数据。
利用基于人群的监测、流行病学和最终结果（SEER）登记处的数据，确定了所有年龄≥65岁、1991年诊断为局部或区域结直肠癌、接受了手术切除且诊断后存活至少6个月的患者。检查了从诊断后6个月至1994年的所有住院、医院门诊以及医生/供应商的医疗保险理赔记录，以查找感兴趣的随访程序。使用双变量和多变量分析比较了不同患者组随访期间的程序使用情况。
共识别出5716例患者，其中1.3%被发现随后发生了结肠或直肠癌的原发性肿瘤，74%存活至1994年。88%的患者进行了一项或多项感兴趣的程序；最常进行的检查是肝酶、胸部X线、结肠镜检查和计算机断层扫描。年龄较大的组、合并症较少的患者以及未存活至随访期结束的患者的检测率通常较低。在所有研究的程序中，9个SEER地区的检测率也存在显著差异，相差1.5倍至3.6倍。在调整了潜在混杂因素的多变量模型中，地理差异仍然存在。
当前研究发现随访程序的使用存在显著差异，最明显的差异出现在不同地理区域之间。需要进一步研究以确定差异的潜在原因以及监测对患者结局的影响。
