Division of Surgical Oncology, Department of Surgery, University of Louisville, James Graham Brown Cancer Center and Center for Advanced Surgical Technologies of Norton Hospital Louisville, Louisville, KY, USA.
Surgery. 2010 Oct;148(4):711-6; discussion 716-7. doi: 10.1016/j.surg.2010.07.042. Epub 2010 Aug 30.
Current recommendations by the National Comprehensive Cancer Network and other groups suggest that follow-up of cutaneous melanoma may include chest radiography (CXR) at 6- to 12-month intervals. The aim of this study was to determine the clinical efficacy of routine CXR for recurrence surveillance in melanoma.
Post hoc analysis was performed on data from a prospective, randomized, multi-institutional study on melanoma ≥1.0 mm in Breslow thickness. All patients underwent excision of the primary melanoma and sentinel node biopsy with completion lymphadenectomy for positive sentinel nodes. Yearly CXR and clinical assessments were obtained during follow-up. Results of routine CXR were compared with clinical disease states over the course of the study.
A total of 1,235 patients were included in the analysis over a median follow-up of 74 months (range, 12-138). Overall, 210 patients (17.0%) had a recurrence, most commonly local or in-transit. Review of CXR results showed that 4,218 CXR were obtained in 1,235 patients either before, or in the absence of, initial recurrence. To date, 88% (n = 3,722) CXR are associated with no evidence of recurrence. Of CXR associated with recurrence, only 7.7% (n = 38) of surveillance CXR were read as "abnormal." Overall, 99% (n = 4,180) of CXR were read as either "normal" or found to be falsely positive (read as "abnormal," but without evidence of recurrence on investigation). Only 0.9% (n = 38) of all CXR obtained were true positives ("abnormal" CXR, with confirmed first known recurrence). Among these 38 patients with true positive CXR, 35 revealed widely disseminated disease (multiorgan or bilateral pulmonary metastases); only 3 (0.2%) had isolated pulmonary metastases amenable to resection. Sensitivity and specificity for surveillance CXR in detecting initial recurrence were 7.7% and 96.5%, respectively.
The routine use of surveillance CXR provides no clinically useful information in the follow-up of patients with melanoma. CXR does not detect recurrence at levels sufficient to justify its routine use and, therefore, cannot be recommended as part of the standard surveillance regimen for these patients.
目前，美国国家综合癌症网络（National Comprehensive Cancer Network）和其他组织的建议指出，皮肤黑色素瘤的随访可以包括每 6-12 个月进行一次胸部 X 线检查（CXR）。本研究旨在确定常规 CXR 对黑色素瘤复发监测的临床效果。
对一项前瞻性、随机、多机构研究中厚度≥1.0mm 的黑色素瘤患者的数据进行了事后分析。所有患者均接受了原发黑色素瘤切除术和前哨淋巴结活检，如果前哨淋巴结阳性，则进行淋巴结清扫术。在随访期间，每年进行 CXR 和临床评估。将常规 CXR 的结果与研究过程中的临床疾病状态进行比较。
在中位随访 74 个月（范围 12-138）的情况下，共 1235 例患者纳入分析。总体而言，210 例（17.0%）患者出现复发，最常见的是局部或远处转移。回顾 CXR 结果显示，在 1235 例患者中，有 4218 例在初次复发前或无复发时进行了 CXR。迄今为止，88%（n=3722）的 CXR 无复发证据。在与复发相关的 CXR 中，只有 7.7%（n=38）的监测 CXR 被读为“异常”。总的来说，99%（n=4180）的 CXR 被读为“正常”或假阳性（读为“异常”，但经检查无复发证据）。只有 0.9%（n=38）的 CXR 为真阳性（“异常”CXR，伴有首次已知复发）。在这 38 例真阳性 CXR 患者中，35 例患者有广泛播散性疾病（多器官或双侧肺转移）；只有 3 例（0.2%）有孤立性肺转移，可切除。监测 CXR 检测初始复发的敏感性和特异性分别为 7.7%和 96.5%。
常规使用监测 CXR 并不能为黑色素瘤患者的随访提供有临床意义的信息。CXR 无法检测到足以证明其常规使用的复发水平，因此不能作为这些患者标准监测方案的一部分推荐。
