Division of Pulmonary and Critical Care Medicine, University of California, Irvine, Orange, CA.
Division of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL.
Chest. 2013 May;143(5 Suppl):e437S-e454S. doi: 10.1378/chest.12-2365.
These guidelines are an update of the evidence-based recommendations for follow-up and surveillance of patients after curative-intent therapy for lung cancer. Particular updates pertain to whether imaging studies, health-related quality-of-life (HRQOL) measures, tumor markers, and bronchoscopy improve outcomes after curative-intent therapy.
Meta-analysis of Observational Studies in Epidemiology guidelines were followed for this systematic review, including published studies on posttreatment outcomes in patients who received curative-intent therapy since the previous American College of Chest Physicians subject review. Four population, intervention, comparison, and outcome questions were formulated to guide the review. The MEDLINE and CINAHL databases were searched from June 1, 2005, to July 8, 2011, to ensure overlap with the search strategies used previously.
A total of 3,412 citations from MEDLINE and 431 from CINAHL were identified. Only 303 were relevant. Seventy-six of the 303 articles were deemed eligible on the basis of predefined inclusion criteria after full-text review, but only 34 provided data pertaining directly to the subject of the questions formulated to guide this review. In patients undergoing curative-intent surgical resection of non-small cell lung cancer, chest CT imaging performed at designated time intervals after resection is suggested for detecting recurrence. It is recommended that treating physicians who are able to incorporate the patient's clinical findings into decision-making processes be included in follow-up and surveillance strategies. The use of validated HRQOL instruments at baseline and during follow-up is recommended. Biomarker testing during surveillance outside clinical trials is not suggested. Surveillance bronchoscopy is suggested for patients with early central airway squamous cell carcinoma treated by curative-intent photodynamic therapy and for patients with intraluminal bronchial carcinoid tumor who have undergone curative-intent bronchoscopic treatment with Nd:YAG laser or electrocautery.
There is a paucity of well-designed prospective studies specifically targeting follow-up and surveillance modalities aimed at improving survival or QOL after curative-intent therapy. Additional research is warranted to clarify which curative-intent treatment modalities affect HRQOL the most and to identify patients who are at the most risk for recurrence or impaired QOL after treatment. Further evidence is needed to determine how the frequency and duration of surveillance programs that include imaging studies, QOL measurements, tumor markers, or bronchoscopy affect patient morbidity, survival, HRQOL, and health-care costs.
本指南是对以治愈为目的的肺癌治疗后患者进行随访和监测的循证推荐更新。具体更新内容涉及影像学检查、健康相关生命质量（HRQOL）评估、肿瘤标志物和支气管镜检查是否能改善治愈性治疗后的结局。
本系统评价遵循观察性研究的荟萃分析指南，包括自前一次美国胸科学会（ACCP）专题审查以来，接受治愈性治疗的患者在治疗后结局方面的已发表研究。制定了 4 个人群、干预、比较和结局问题来指导该评价。从 2005 年 6 月 1 日至 2011 年 7 月 8 日，检索 MEDLINE 和 CINAHL 数据库，以确保与之前使用的检索策略重叠。
从 MEDLINE 中获得 3412 条引文，从 CINAHL 中获得 431 条引文。仅有 303 条引文与研究相关。在进行全文审查后，根据预先确定的纳入标准，共有 76 篇文章被认为符合入选标准，但仅有 34 篇文章提供的数据直接涉及为指导本次评价而制定的问题。在接受非小细胞肺癌根治性手术切除的患者中，建议在术后指定时间间隔行胸部 CT 影像学检查以检测复发。建议将能够将患者的临床发现纳入决策过程的治疗医师纳入随访和监测策略中。建议在基线和随访期间使用经过验证的生命质量（HRQOL）量表。不建议在临床试验之外进行生物标志物检测。建议对接受根治性光动力治疗的早期中央气道鳞状细胞癌患者和接受 Nd:YAG 激光或电烙术根治性支气管镜治疗的腔内支气管类癌患者进行支气管镜监测。
目前，缺乏专门针对旨在提高治愈性治疗后生存率或生命质量的随访和监测方法的精心设计的前瞻性研究。需要进一步研究来明确哪些治愈性治疗方式对 HRQOL 的影响最大，并确定哪些患者在治疗后复发或生命质量受损的风险最高。需要进一步的证据来确定包括影像学检查、生命质量测量、肿瘤标志物或支气管镜检查在内的监测方案的频率和持续时间如何影响患者的发病率、生存率、生命质量和医疗保健成本。
