Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2010 Dec;22(10):868-73. doi: 10.1016/j.clon.2010.05.016. Epub 2010 Jul 21.
To determine the value of routine follow-up in detecting and salvaging recurrence after radical treatment of locally advanced head and neck squamous cell carcinoma and to identify clinical or pathological prognostic factors that predicted for survival.
A retrospective medical chart review was conducted at the Odette Cancer Centre between January 2000 and May 2006. Two hundred and twenty-three patients with advanced (stage III or IV) squamous cell carcinoma of the head and neck who were treated with curative intent were reviewed. Recurrences were divided into local, regional or distant recurrences. The detection method for each recurrence was categorised as self or physician detected. A self-detected recurrence arose from symptoms that led to investigations that confirmed a recurrence (even if initiated at the time of a routine visit), whereas a physician-detected recurrence was found during the routine follow-up examination and was asymptomatic.
There was no evidence to suggest a significant improvement in disease-free or overall survival in the physician-detected versus patient-detected groups. Regional and distant recurrences were only detected by physicians in one-fifth of cases and, overall, patients self-detected their own recurrence in two-thirds of the cases that experienced disease progression within the sample. Of the 12 clinical/pathological variables considered, only the response to treatment and perineural invasion were associated with survival.
Current surveillance methods do not appear to improve cancer control in the stage III/IV head and neck squamous cell carcinoma population. However, technological advances and biomarker development may lead to surveillance technique enhancements. Also, post-treatment follow-up remains important for the evaluation of treatment results, emotional support and management of late complications. Among the clinical and pathological factors considered, only the treatment response and perineural invasion predicted survival.
确定在根治性治疗局部晚期头颈部鳞状细胞癌后进行常规随访以检测和挽救复发的价值，并确定预测生存的临床或病理预后因素。
在奥代特癌症中心（Odette Cancer Centre）进行了回顾性病历审查，时间范围为 2000 年 1 月至 2006 年 5 月。共回顾了 223 例接受根治性治疗的晚期（III 期或 IV 期）头颈部鳞状细胞癌患者。将复发分为局部、区域或远处复发。将每种复发的检测方法分为自行或医生发现。自行发现的复发是由导致进行证实复发的检查的症状引起的（即使是在常规就诊时开始），而医生发现的复发是在常规随访检查中发现的，且无症状。
没有证据表明在医生发现的与患者发现的疾病无进展或总体生存方面有显著改善。区域和远处复发仅在五分之一的病例中由医生发现，而且，在样本中经历疾病进展的病例中，有三分之二的患者自行发现了自己的复发。在所考虑的 12 个临床/病理变量中，只有治疗反应和神经周围侵犯与生存相关。
目前的监测方法似乎并未改善 III/IV 期头颈部鳞状细胞癌患者的癌症控制。然而，技术进步和生物标志物的发展可能会导致监测技术的改进。此外，治疗后随访对于评估治疗效果、提供情感支持和管理晚期并发症仍然很重要。在所考虑的临床和病理因素中，只有治疗反应和神经周围侵犯预测生存。
