Department of General Surgery, Ulster Hospital, Newtownards Road, Dundonald, Co. Down, BT16 1RH, United Kingdom.
Surgeon. 2011 Apr;9(2):61-4. doi: 10.1016/j.surge.2010.06.009. Epub 2010 Jul 31.
Little evidence exists regarding the optimum frequency or duration of follow-up for patients with breast cancer. The aim of this study was to assess the effectiveness of a risk-stratified follow-up programme.
Patients treated surgically for primary breast cancer from January 2000 to September 2006 were recorded on a BASO database. Follow-up was stratified according to risk of relapse as determined by the Nottingham Prognostic Index (NPI). Patients were assigned to high, moderate or low risk groups. The date of recurrence, time from primary diagnosis and site of relapse were obtained from the database. Review of case notes was used to confirm the method of detection.
1303 women had surgery for primary breast cancer in the study period. Median follow-up was 40 months. Overall survival rate was 96.9% (90.4% high, 97.3% moderate, 99.5% low). Disease free survival was 94.1% (84.1% high, 94.7% moderate, 98.1% low). Seventy-seven recurrences were detected with 39 (51%) in the high risk group, 27 (35%) in the moderate risk group and 11 (14%) in the low risk group. Detection rate at a scheduled appointment was 0.27% overall (low risk 0.14%, moderate risk 0.27%, high risk 0.45%).
NPI correlates with risk of recurrent disease. Scheduled follow-up yielded few recurrences, suggesting early discharge with open access to clinics could be a safe alternative. This type of follow-up may reduce demand on specialist clinics without significantly affecting patient care or overall survival.
关于乳腺癌患者的随访最佳频率或持续时间，目前证据有限。本研究旨在评估风险分层随访计划的有效性。
从 2000 年 1 月至 2006 年 9 月，对接受手术治疗的原发性乳腺癌患者进行了 BASO 数据库记录。根据诺丁汉预后指数（NPI）确定的复发风险对随访进行分层。将患者分为高、中、低风险组。从数据库中获得复发日期、从原发性诊断到复发的时间以及复发部位。通过复查病历来确认检测方法。
在研究期间，有 1303 名女性接受了原发性乳腺癌手术。中位随访时间为 40 个月。总生存率为 96.9%（高风险组为 90.4%，中风险组为 97.3%，低风险组为 99.5%）。无病生存率为 94.1%（高风险组为 84.1%，中风险组为 94.7%，低风险组为 98.1%）。共发现 77 例复发，其中高风险组 39 例（51%），中风险组 27 例（35%），低风险组 11 例（14%）。在预定预约时的检出率为 0.27%（低风险组为 0.14%，中风险组为 0.27%，高风险组为 0.45%）。
NPI 与疾病复发风险相关。定期随访发现的复发病例较少，这表明早期出院并开放诊所就诊可能是一种安全的替代方案。这种类型的随访可以减少对专科诊所的需求，而不会对患者护理或总体生存率产生重大影响。
