Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Int J Gynecol Cancer. 2011 May;21(4):647-53. doi: 10.1097/IGC.0b013e318212b87d.
Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.
All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.
The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P = 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P = 0.26).
Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.
在接受治愈性治疗的卵巢癌患者中，常规随访是标准的医疗实践。然而，目前尚无强有力的证据表明预后得到改善。本研究的目的是评估卵巢癌患者的常规随访计划，包括对荷兰方案的依从性、复发的检测以及随访对总生存的影响。
选择 1996 年至 2006 年期间荷兰 4 家医院诊断的上皮性卵巢癌、原发性腹膜癌或输卵管癌的 579 例连续患者。仅研究在原发性治疗后完全临床缓解的患者。在 68 例随机样本中评估对荷兰随访指南的依从性。在 127 例复发患者中，确定了复发的检测方式。使用 Kaplan-Meier 方法计算自原发性治疗后的生存时间。
患者接受的随访次数超过了指南推荐的次数。累积 5 年复发风险为 55%（95%置信区间[CI]，43%-67%）。在常规就诊时无症状检测到复发的患者（n=51）的生存时间与在常规就诊时出现症状检测到复发的患者（n=31）或在间隔就诊时诊断出复发的患者（n=31）相比，倾向于更好。中位生存时间分别为 44（95%CI，38-64）、29（95%CI，21-38）和 33 个月（95%CI，19-61）（P=0.08）。3 组从原发性治疗到复发的中位时间相似：分别为 14、10 和 11 个月（P=0.26）。
如果复发是无症状检测到的，那么遵循（国际）指南进行随访似乎会延长预期寿命。然而，这一结果预计是由肿瘤生物学和时间偏倚的差异造成的。
