Francken Anne Brecht, Bastiaannet Esther, Hoekstra Harald J
Division of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
Lancet Oncol. 2005 Aug;6(8):608-21. doi: 10.1016/S1470-2045(05)70283-7.
Follow-up services for patients with localised cutaneous melanoma are widely discussed but there is no international consensus. Our aim was to discuss frequency and duration of follow-up, type of health professional involved, optimum intensity of routine investigation, and patients' satisfaction with follow-up. Searches of the published work were directed at publications between January, 1985, and February, 2004 on recurrences, subsequent primary melanoma, routine tests, and patients' satisfaction. In a selection of 72 articles, 2142 (6.6%) recurrences were reported, 62% of which were detected by the patients themselves. 2.6% of patients developed a subsequent primary melanoma. Most investigators do not support high-intensity routine follow-up investigations. Of the various follow-up investigations requested by physicians, only medical history and physical examination seem to be cost effective. Lymph-node sonography seems to be a promising method for detection, although survival benefit remains to be proven. Patients were found to be anxious about follow-up visits, although other research showed that provision of information to patients was much appreciated. Published work on the follow-up of patients with cutaneous melanoma has mainly been retrospective and descriptive. Recommendations can be given with only a low grade of evidence. For meaningful guidelines to be developed, prospective, high-quality methodological research is needed.
对于局限性皮肤黑色素瘤患者的随访服务已得到广泛讨论，但尚未形成国际共识。我们的目的是探讨随访的频率和时长、参与的医疗专业人员类型、常规检查的最佳强度以及患者对随访的满意度。对已发表文献的检索针对1985年1月至2004年2月间关于复发、后续原发性黑色素瘤、常规检查及患者满意度的出版物。在筛选出的72篇文章中，报告了2142例（6.6%）复发，其中62%是由患者自身发现的。2.6%的患者出现了后续原发性黑色素瘤。大多数研究者不支持高强度的常规随访检查。在医生要求的各种随访检查中，只有病史和体格检查似乎具有成本效益。淋巴结超声检查似乎是一种有前景的检测方法，尽管其对生存的益处仍有待证实。患者对随访就诊感到焦虑，不过其他研究表明，向患者提供信息很受赞赏。关于皮肤黑色素瘤患者随访的已发表文献主要是回顾性和描述性的。给出的建议证据等级较低。要制定有意义的指南，需要开展前瞻性、高质量的方法学研究。
