The utility of routine follow-up procedures in the surveillance of uterine cancer: a 20-year institutional review.

OBJECTIVES

The purpose of this study was to assess the value of routine follow-up procedures during uterine cancer surveillance and the corresponding cost throughout a 20-year period at a single medical institution.

METHODS

We sought to determine which surveillance method (CA-125, imaging, physical examination or vaginal cytology) detected the highest number of patient recurrences and the corresponding cost vis-à-vis the number of identified progressive disease cases.

RESULTS

Serial imaging detected the highest number of progressive disease cases but the cost was rather high (USD 17,174 per patient recurrence), whereas CA-125 testing was the least expensive (USD 6,810 per patient recurrence). We also found that those with a variant histology [for example, adenosquamous and uterine papillary serous carcinoma (p < 0.001) and advanced (III/IV) disease stage (p = 0.001)] were associated with an unfavorable progression-free interval.

CONCLUSIONS

In the present investigation, serial imaging detected the highest number of progressive disease cases, although no single surveillance method was associated with a sensitive recurrent disease detection rate. Nevertheless, the CA-125 assay appeared to be the most cost-effective method in following patients with epithelial uterine malignancies. Thus, in the context of high-risk disease, a combination of procedures may still be necessary for optimal uterine cancer patient follow-up.