Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
Ann Surg Oncol. 2011 Feb;18(2):358-64. doi: 10.1245/s10434-010-1395-3. Epub 2010 Nov 2.
While clinicians routinely follow up gastric cancer patients after curative resection to detect recurrence, the effectiveness of regular follow-up has not been proven, and no consensus has been reached regarding follow-up programs.
Of the 1,767 patients who underwent curative resection for gastric cancer from 2001 to 2004, 310 (17.5%) developed recurrence during follow-up. The oncologic effectiveness of follow-up was evaluated using recurrence detection rates during follow-up and survivals. Clinicopathologic characteristics, the detection tools used, and times lapsed between recurrence and previous examinations were also investigated.
Two hundred thirty-three (75.2%) of the 310 patients who developed recurrence were detected by regular follow-up (detected group). The frequencies of undifferentiated and diffuse-type recurrences were higher in patients with recurrence detected based on patient-initiated findings (undetected group) than in the detected group. Computed tomography and tumor markers were the first detection tools that yielded positive findings. Times between recurrence detection and previous examinations ranged from 2.8 to 5.3 months over the first 2 years. No difference in overall survival was found between the detected and undetected groups (log rank, P = 0.2).
The oncologic effectiveness of regular follow-up after curative resection for gastric cancer was found to be unsatisfactory. A large-scale randomized controlled trial is required to identify the effectiveness of regular follow-up in terms of its oncologic, functional, psychological, and economical aspects.
尽管临床医生通常会在根治性切除术后对胃癌患者进行随访以检测复发，但定期随访的效果尚未得到证实，并且对于随访方案也没有达成共识。
在 2001 年至 2004 年间接受根治性胃切除术的 1767 例患者中，有 310 例（17.5%）在随访期间复发。通过随访期间的复发检测率和生存率评估随访的肿瘤学效果。还研究了临床病理特征、使用的检测工具以及复发与前一次检查之间的时间间隔。
在 310 例复发患者中，有 233 例（75.2%）通过常规随访（检测组）发现。与通过患者主动发现（未检测组）而发现的复发患者相比，检测组中未分化型和弥漫型复发的频率更高。计算机断层扫描和肿瘤标志物是首次发现阳性结果的检测工具。在头 2 年内，从复发检测到前一次检查的时间间隔为 2.8 至 5.3 个月。检测组和未检测组之间的总体生存率无差异（对数秩检验，P=0.2）。
根治性切除术后常规随访的肿瘤学效果并不令人满意。需要进行大规模的随机对照试验，以确定常规随访在肿瘤学、功能、心理和经济学方面的有效性。
