Whiting John, Sano Takeshi, Saka Makoto, Fukagawa Takeo, Katai Hitoshi, Sasako Mitsuru
University Hospital Birmingham, Birmingham, UK.
Gastric Cancer. 2006;9(2):74-81. doi: 10.1007/s10120-006-0360-0.
Although there is broad agreement in the staging, classification, and surgery for gastric cancer, there is no consensus regarding follow-up after gastrectomy. Follow-up varies from investigations on clinical suspicion of relapse to intensive investigations to detect recurrences early, assuming that this improves survival and quality of life. Advanced gastric cancers recur mainly by locoregional recurrence or distant metastasis. Local recurrences detected at endoscopy or on computed tomography (CT) are invariably incurable. For early gastric cancers, endoscopy can detect new primaries, but the incidence of these tumors is low, and many thousands of procedures are required to detect each operable case. CT is much better at detecting liver metastasis and, although these are usually multiple and unresectable, there are several reports of good survival following liver resection for isolated metastasis. Tumor markers have been used with some success to detect subclinical recurrences and could be used to target more invasive or expensive procedures. In chemotherapy, many newer agents are promising significantly improved survival, but again, the evidence for greater benefit when administered prior to the patient becoming symptomatic is lacking. Overall, it appears that follow-up policy is as much decided by the wealth and facilities of the institution as by any significant evidence base. Although the early detection of recurrent cancer is an emotive issue for both patients and surgeons, considering the amount of time and money invested in follow-up, and the lack of evidence of efficacy, a randomized controlled trial of intensive follow-up is required.
尽管在胃癌的分期、分类及手术方面已达成广泛共识，但对于胃切除术后的随访尚无一致意见。随访方式各异，从基于临床怀疑复发进行的检查到旨在早期发现复发的密集检查，人们认为这样能提高生存率和生活质量。进展期胃癌主要通过局部区域复发或远处转移复发。在内镜检查或计算机断层扫描（CT）中发现的局部复发往往无法治愈。对于早期胃癌，内镜检查可发现新的原发肿瘤，但这类肿瘤的发生率较低，发现每一例可手术病例都需要进行数千次检查。CT在检测肝转移方面效果更佳，尽管肝转移通常为多发且不可切除，但有几份报告显示，对孤立性转移灶进行肝切除术后患者生存良好。肿瘤标志物在检测亚临床复发方面已取得一定成功，可用于指导更具侵入性或费用更高的检查。在化疗方面，许多新型药物有望显著提高生存率，但同样缺乏在患者出现症状之前给药能带来更大益处的证据。总体而言，随访策略似乎更多地取决于机构的财力和设施，而非任何重要的证据基础。尽管对患者和外科医生来说，早期发现复发性癌症都是一个激动人心的问题，但考虑到随访投入的时间和金钱，以及缺乏疗效证据，需要开展一项关于密集随访的随机对照试验。
