我们应该随访软组织肉瘤患者多长时间？
How long should we follow patients with soft tissue sarcomas?
机构信息
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan,
出版信息
Clin Orthop Relat Res. 2014 Mar;472(3):842-8. doi: 10.1007/s11999-013-3076-6.
BACKGROUND
Guidelines suggest that followup for low-grade soft tissue sarcomas should be every 3 to 6 months for 2 to 3 years and then annually, and for high-grade sarcomas every 3 to 6 months for 2 to 5 years, then every 6 months for the next 2 years, and then annually. However, there is only very limited evidence to support these strategies.
QUESTIONS/PURPOSES: In a population of patients treated surgically for soft tissue sarcomas, we evaluated the (1) timing of diagnosis of local recurrences after sarcoma excision; (2) timing of diagnosis of distant metastases; and (3) the difference in those parameters based on tumor size and grade.
METHODS
Patients diagnosed with soft tissue sarcomas and who underwent surgical excision between 1978 and 2008 were retrospectively reviewed. Age, histologic diagnosis, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, tumor location, and size were reviewed at a mean of 6 years (range, 1 month to 30 years). We met with patients every 3 months for 5 years, every 6 months for 10 years, and then annually until 15 years after surgery. Eight hundred sixty-seven patients with a median age at diagnosis of 52 years were eligible for analysis. The incidence of local recurrence and metastases was calculated for every 2-year period and presented per 1000 person-years.
RESULTS
Ninety-eight patients (11%) developed local recurrence at a median time of 19 months; 90% of patients who had local recurrences had them within 7.1 years, and 95% occurred by 8.6 years. One hundred ninety-eight patients (23%) developed distant metastases at a median time of 12 months; 90% of patients who developed metastases developed them by 4.2 years and 95% did so by 7.3 years. High-grade tumors had a higher incidence of local recurrence and metastases in first 2 years, whereas low-grade tumors recurred at a constant rate throughout the followup period.
CONCLUSIONS
Followup beyond 10 years does not yield a sufficient number of local recurrences or metastases to warrant further monitoring.
LEVEL OF EVIDENCE
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
指南建议低度软组织肉瘤的随访间隔应为每 3 至 6 个月 2 至 3 年，然后每年一次；而高度肉瘤的随访间隔应为每 3 至 6 个月 2 至 5 年，然后每 6 个月 2 年，然后每年一次。然而，仅有非常有限的证据支持这些策略。
问题/目的：在接受手术治疗的软组织肉瘤患者人群中，我们评估了（1）肉瘤切除后局部复发的诊断时间；（2）远处转移的诊断时间；以及（3）基于肿瘤大小和分级的这些参数的差异。
方法
回顾性分析了 1978 年至 2008 年间接受手术切除的软组织肉瘤患者。在平均 6 年（1 个月至 30 年）的时间内，回顾了患者的年龄、组织学诊断、法国国家癌症中心联合会（FNCLCC）分级、肿瘤位置和大小。我们每 3 个月与患者见面 5 年，每 6 个月见面 10 年，然后每年见面直至术后 15 年。867 名中位年龄为 52 岁的患者符合分析条件。每 2 年计算一次局部复发和转移的发生率，并以每 1000 人年为单位呈现。
结果
98 名患者（11%）在中位时间 19 个月时出现局部复发；90%的局部复发患者在 7.1 年内出现复发，95%的患者在 8.6 年内出现复发。198 名患者（23%）在中位时间 12 个月时出现远处转移；90%的发生转移的患者在 4.2 年内发生转移，95%的患者在 7.3 年内发生转移。高级别肿瘤在前 2 年的局部复发和转移发生率较高，而低级别肿瘤在整个随访期间以恒定的速度复发。
结论
超过 10 年的随访并未产生足够数量的局部复发或转移，因此无需进一步监测。
证据水平
II 级，预后研究。有关证据水平的完整描述，请参阅作者指南。
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