Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
Gastric Cancer. 2012 Sep;15 Suppl 1:S164-7. doi: 10.1007/s10120-012-0142-9. Epub 2012 Mar 2.
Complete resection of a gastric cancer and adjacent lymph nodes offers the only chance for cure of the disease. However, disease recurrence occurs in 22-51% of cases, and its prognosis is very poor. Many clinicians perform post-operative follow-up for these patients, although there is no consensus on the regimen, frequency of visits, mode of testing, or the rationale of a follow-up program.
The objective of this systematic review was to identify the evidence for surveillance in patients with resected gastric cancer, specifically examining the interval of follow-up and the modalities utilized.
Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1st 1998 to December 1st 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers.
Five articles were selected. A total of 810 patients underwent post-operative follow-up. History and physical examination, hematological and chemistry profile, endoscopy (esophagogastroduodenoscopy [EGD]), and computed tomography (CT) were the most frequently employed modalities. CT detected the majority of recurrences in the included studies. The survival post-recurrence was significantly higher in the asymptomatic group compared with symptomatic group in three studies, but this may simply reflect lead-time bias. No differences in overall survival (OS) were found.
The included studies failed to show an improvement in OS with more intense surveillance. Further prospective studies are required to determine whether a subgroup of patients may benefit from more intensive follow-up.
胃癌的完全切除和邻近淋巴结的清扫为治愈该疾病提供了唯一机会。然而，22-51%的病例会出现疾病复发，且其预后非常差。许多临床医生对这些患者进行术后随访，但对于随访方案、就诊频率、检查方式或随访计划的原理尚未达成共识。
本系统综述的目的是确定对接受胃癌根治术患者进行监测的证据，具体研究内容为随访间隔时间和使用的方法。
通过 Medline、Embase 和 Cochrane 对照试验中心注册库，对 1998 年 1 月 1 日至 2009 年 12 月 1 日期间发表的文献进行电子检索。所有检索标题和摘要均由至少两名评审员独立评估相关性。
共选择了 5 篇文章。共有 810 例患者接受了术后随访。病史和体格检查、血液和化学检查、内窥镜检查（食管胃十二指肠镜检查[EGD]）和计算机断层扫描（CT）是最常使用的方法。在纳入的研究中，CT 检测到了大多数复发病例。在 3 项研究中，无症状组的复发后生存率明显高于有症状组，但这可能只是反映了领先时间偏倚。在总生存（OS）方面未发现差异。
纳入的研究未能表明更密集的监测可改善 OS。需要进一步的前瞻性研究来确定是否有一部分患者可能受益于更密集的随访。
