Mabuchi Seiji, Isohashi Fumiaki, Maruoka Shintaro, Hisamatsu Takeshi, Takiuchi Tsuyoshi, Yoshioka Yasuo, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
Arch Gynecol Obstet. 2012 Jul;286(1):179-85. doi: 10.1007/s00404-012-2235-4. Epub 2012 Jan 28.
We investigated the role of physical examination, CT scan, chest X-ray, and Pap smear in the routine follow-up program for cervical cancer patients previously treated with radiotherapy.
The records of women who had developed recurrent cervical cancer after radiotherapy were retrospectively reviewed. The optimal procedure for the detection of recurrence was evaluated according to the disease-free interval (DFI). Survival analysis was performed based on the Kaplan-Meier method and comparisons between groups were made using the log-rank test.
A total of 146 recurrent cervical cancer patients were included in our database. The majority of recurrences were diagnosed either by symptoms, physical examination, or CT scan. The patients whose recurrent disease was detected by Pap smear, physical examination, or CT scan had a significantly longer survival than those detected by symptoms. When analyzed according to DFI, physical examination, and CT scan led to the detection of recurrence in patients with a DFI of 1-5 years. In contrast, chest X-ray and Pap smear only had a clinical impact on the diagnosis of recurrence in patients with a DFI of 1-2 years.
Chest X-ray and Pap smear can be routinely performed for the first 2 years after radiotherapy, but can be omitted or used sparingly thereafter.
我们研究了体格检查、CT扫描、胸部X线检查和巴氏涂片检查在先前接受放疗的宫颈癌患者常规随访程序中的作用。
对放疗后发生复发性宫颈癌的女性患者记录进行回顾性分析。根据无病间期（DFI）评估检测复发的最佳程序。采用Kaplan-Meier法进行生存分析，组间比较采用对数秩检验。
我们的数据库共纳入146例复发性宫颈癌患者。大多数复发是通过症状、体格检查或CT扫描诊断出来的。通过巴氏涂片检查、体格检查或CT扫描检测到复发性疾病的患者的生存期明显长于通过症状检测到复发性疾病的患者。根据DFI进行分析时，体格检查和CT扫描可检测出DFI为1至5年患者的复发情况。相比之下，胸部X线检查和巴氏涂片检查仅对DFI为1至2年患者的复发诊断有临床影响。
放疗后的前2年可常规进行胸部X线检查和巴氏涂片检查，但此后可省略或酌情使用。
