Beisland Christian, Guðbrandsdottir Gigja, Reisæter Lars A R, Bostad Leif, Hjelle Karin M
Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
World J Urol. 2016 Aug;34(8):1087-99. doi: 10.1007/s00345-016-1796-4. Epub 2016 Feb 27.
In mid-2007, we introduced a new risk-stratified follow-up programme (FUP) for surgically treated localized renal cell carcinoma. After inclusion, the patients have been followed prospectively. In this study, we present the results in regard to stratification, completeness of the FUP and recurrences.
The FUP consists of three risk groups: low risk (LR), intermediate risk (IR) and high risk (HR), based on the risk stratification model introduced by Leibovich et al. (Cancer 97(7):1663-1671, 2003). In all risk groups, the patients are scheduled for ten follow-up visits (FUV) over 5 years, but seven, five and three FUVs, respectively, are outsourced to the patient's general practitioner (GP). Chest X-ray and abdomen CT are the imaging modalities used in the FUP.
Of 312 included patients, 195 (62.5 %) had a complete FUP. However, in 86 patients the scheduled FUP had to be reduced, leaving 86.3 % of the remaining patients with a complete FUP. By including GPs, the number of FUVs at the hospital was reduced by ~60 %. The 5-year probability for freedom of recurrence is 0.98, 0.84 and 0.52 for the LR, IR and HR groups, respectively. Of 31 recurrences, 20 patients (65 %) were diagnosed within the FUP. Eleven patients (35 %) were diagnosed due to symptoms, and five of these had recurrences in locations not covered by standard imaging. Patients diagnosed within the FUP showed a better prognosis for survival and could in greater part receive tumour-directed treatment.
After 8 years of clinical use, the outcome measures of the FUP seem to be within acceptable ranges.
2007年年中，我们为接受手术治疗的局限性肾细胞癌引入了一项新的风险分层随访计划（FUP）。纳入患者后，对其进行前瞻性随访。在本研究中，我们展示了关于分层、随访完整性和复发情况的结果。
基于Leibovich等人（《癌症》97(7):1663 - 1671, 2003年）引入的风险分层模型，FUP包括三个风险组：低风险（LR）、中风险（IR）和高风险（HR）。在所有风险组中，患者计划在5年内进行10次随访（FUV），但分别有7次、5次和3次FUV外包给患者的全科医生（GP）。胸部X光和腹部CT是FUP中使用的成像方式。
在312例纳入患者中，195例（62.5%）完成了完整的FUP。然而，86例患者的计划随访不得不减少，剩余患者中有86.3%完成了完整的FUP。通过纳入全科医生，医院的FUV数量减少了约60%。LR、IR和HR组的5年无复发生存概率分别为0.98、0.84和0.52。在31例复发患者中，20例（65%）在FUP期间被诊断出。11例（35%）患者因症状被诊断出，其中5例的复发部位不在标准成像范围内。在FUP期间被诊断出的患者生存预后较好，并且大部分能够接受针对肿瘤的治疗。
经过8年的临床应用，FUP的结果指标似乎在可接受范围内。
