Beitler A L, Virgo K S, Johnson F E, Gibbs J F, Kraybill W G
Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York 14263, USA.
Cancer. 2000 Feb 15;88(4):777-85.
The follow-up of patients after potentially curative resection of extremity sarcomas has significant clinical and fiscal implications. However, the ideal postoperative surveillance regimen for these uncommon neoplasms remains ill-defined. This study was designed to determine the current follow-up practices of a large, diverse group of physicians who care for sarcoma patients.
The 1592 members of the Society of Surgical Oncology (SSO) were surveyed regarding their follow-up practices with a detailed questionnaire mailed in 1997. Information regarding frequency of follow-up testing was requested for extremity sarcoma patients treated for cure based on 4 vignettes: low grade lesion </= 5 cm and > 5 cm and high grade lesion </= 5 cm and > 5 cm. Respondents were asked to indicate the number of office visits, laboratory tests and imaging studies performed annually during the first 5 years and the 10th year after surgery.
Forty-five percent (716 of 1592) completed the survey. Of the 343 respondents who performed sarcoma surgery, 318 (93%) also provided long term postoperative follow-up for their patients. Ninety-four percent of respondents (295 of 318) were trained in general surgery and 5% (15 of 318) completed orthopedic residencies. Ninety-one percent (291 of 318) were also fellowship trained (80% in surgical oncology). Sixty-three percent (201 of 318) were in academic practice. Routine office visits and chest X-ray (CXR) were the most frequently performed items for each of the years. The frequency of office visits and CXR increased with tumor size and grade and decreased with postoperative year. Complete blood count and liver function tests were the most commonly ordered blood tests, but many respondents did not order any blood tests routinely. Imaging studies of the extremities were performed on the majority of patients with large (> 5 cm) low grade lesions and on both large and small high grade lesions during the first postoperative year.
Postoperative sarcoma surveillance strategies utilized by members of the SSO rely most heavily on office visits and CXR. Tumor grade, tumor size, and postoperative year affect surveillance intensity.
肢体肉瘤根治性切除术后对患者的随访具有重大的临床和经济意义。然而，对于这些罕见肿瘤，理想的术后监测方案仍不明确。本研究旨在确定一大群诊治肉瘤患者的医生当前的随访实践。
1997年通过邮寄详细问卷对外科肿瘤学会（SSO）的1592名成员进行了关于其随访实践的调查。基于4个病例 vignettes，要求提供关于接受根治性治疗的肢体肉瘤患者随访检查频率的信息：低级别病变≤5 cm和＞5 cm，以及高级别病变≤5 cm和＞5 cm。要求受访者指出术后前5年和第10年每年进行的门诊就诊次数、实验室检查和影像学检查次数。
45%（1592名中的716名）完成了调查。在343名进行肉瘤手术的受访者中，318名（93%）也为其患者提供长期术后随访。94%的受访者（318名中的295名）接受过普通外科培训，5%（318名中的15名）完成了骨科住院医师培训。91%（318名中的291名）也接受过专科培训（80%为外科肿瘤学）。63%（318名中的201名）从事学术工作。每年常规门诊就诊和胸部X线检查（CXR）是最常进行的项目。门诊就诊和CXR的频率随肿瘤大小和级别增加而增加，随术后年份减少。全血细胞计数和肝功能检查是最常进行的血液检查，但许多受访者未常规进行任何血液检查。在术后第一年，大多数患有大（＞5 cm）低级别病变的患者以及大小高级别病变的患者都进行了肢体影像学检查。
SSO成员采用的术后肉瘤监测策略最主要依赖门诊就诊和CXR。肿瘤级别、肿瘤大小和术后年份影响监测强度。
