Verwaal V J, Zoetmulder F A N
Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Eur J Surg Oncol. 2004 Apr;30(3):280-5. doi: 10.1016/j.ejso.2003.12.003.
The aim of this study was to determine the value of medical history and physical examination, tumour marker testing, and CT-scanning in the follow-up of patients treated for peritoneal carcinomatosis of colorectal origin.
Between November 1995 and June 2003, 107 patients were treated by cytoreduction and hyperthermic intra-peritoneal chemotherapy. The treatment was considered effective if residual tumour after cytoreduction was no thicker than 2.5 mm. The follow-up consisted of history, physical examination, serum CEA and CA 19.9 testing three-monthly, and CT-scanning of the abdomen six-monthly. Location of the recurrence was categorized into intra-abdominal, hepatic, thoracic, and both intra-abdominal and systemic. The investigation that led to the detection of a recurrence was ranked according to its invasiveness and costs. The simplest investigation that could have led to the detection was marked.
A recurrence developed in 63 patients of the 74 patients effective initial treatment during the study period. Physical examination revealed the recurrence in 38 patients, at least one of the markers was raised above normal value in 39 patients and in 37 patients the CT-scan showed the recurrence. History and physical examination could have triggered the finding of a recurrence in 38 patients, tumour markers in 21 patients and CT-scanning in only three of the 74 recurrences.
Physical examination and tumour marker testing detect most recurrences. CT-scanning is not an effective tool in the follow-up, and should be reserved for on-demand use.
本研究旨在确定病史、体格检查、肿瘤标志物检测以及CT扫描在结直肠源性腹膜癌患者随访中的价值。
1995年11月至2003年6月期间，107例患者接受了细胞减灭术及腹腔内热化疗。若细胞减灭术后残留肿瘤厚度不超过2.5毫米，则认为治疗有效。随访包括每三个月进行一次病史、体格检查、血清癌胚抗原（CEA）和糖类抗原19.9（CA 19.9）检测，以及每六个月进行一次腹部CT扫描。复发部位分为腹腔内、肝脏、胸腔以及腹腔内和全身多处。根据检查的侵入性和成本对导致复发检测的检查进行排序。标记出能够检测到复发的最简单检查。
在研究期间，74例初始治疗有效的患者中有63例出现复发。体格检查发现38例复发，39例患者至少有一种标志物升高至正常范围以上，37例患者的CT扫描显示有复发。病史和体格检查可促使发现38例复发，肿瘤标志物促使发现21例复发，而在74例复发中，CT扫描仅促使发现3例复发。
体格检查和肿瘤标志物检测可发现大多数复发情况。CT扫描并非随访中的有效工具，应按需使用。
