UCLA College of Letters and Science, Los Angeles, Calif., USA.
Oncology. 2010;79(3-4):262-8. doi: 10.1159/000322502. Epub 2011 Mar 4.
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.
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.
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.
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.
本研究旨在评估在一家医疗机构 20 年期间常规随访程序在子宫癌监测中的价值及其相应成本。
我们试图确定哪种监测方法（CA-125、影像学、体格检查或阴道细胞学）检测到最高数量的患者复发，以及与识别出的进展性疾病病例数相对应的相应成本。
连续影像学检测到了最高数量的进展性疾病病例，但成本相当高（每位患者复发 17174 美元），而 CA-125 检测则是最便宜的（每位患者复发 6810 美元）。我们还发现，具有变异组织学的患者[例如，腺鳞癌和子宫内膜乳头状浆液性癌（p < 0.001）和晚期（III/IV）疾病分期（p = 0.001）]与无进展间隔时间不利有关。
在本研究中，连续影像学检测到了最高数量的进展性疾病病例，尽管没有一种单一的监测方法与敏感的复发性疾病检测率相关。然而，CA-125 检测似乎是随访上皮性子宫恶性肿瘤患者最具成本效益的方法。因此，在高危疾病的情况下，为了实现最佳的子宫癌患者随访，可能仍需要结合多种程序。
