Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120, Heidelberg, Germany.
Gastric Cancer. 2018 May;21(3):552-568. doi: 10.1007/s10120-017-0751-4. Epub 2017 Jul 24.
To date there is no evidence that more intensive follow-up after surgery for esophagogastric adenocarcinoma translates into improved survival. This study aimed to evaluate the impact of standardized surveillance by a specialized center after resection on survival.
Data of 587 patients were analyzed who underwent curative surgery for esophagogastric adenocarcinoma in our institution. Based on their postoperative surveillance, patients were assigned to either standardized follow-up (SFU) by the National Center for Tumor Diseases (SFU group) or individual follow-up by other physicians (non-SFU group). Propensity score matching (PSM) was performed to compensate for heterogeneity between groups. Groups were compared regarding clinicopathological findings, recurrence, and impact on survival before and after PSM.
Of 587 patients, 32.7% were in the SFU and 67.3% in the non-SFU group. Recurrence occurred in 39.4% of patients and 92.6% within the first 3 years; 73.6% were treated, and of those 17.1% underwent resection. In recurrent patients overall and post-recurrence survival (OS/PRS) was influenced by diagnostic tools (p < 0.05), treatment (p ≤ 0.001), and resection of recurrence (p ≤ 0.001). Standardized follow-up significantly improved OS (84.9 vs. 38.4 months, p = 0.040) in matched analysis and was an independent positive predictor of OS before and after PSM (p = 0.034/0.013, respectively).
After PSM, standardized follow-up by a specialized center significantly improved OS. Cross-sectional imaging and treatment of recurrence were associated with better outcome. Regular follow-up by cross-sectional imaging especially during the first 3 years should be recommended by national guidelines, since early detection might help select patients for treatment of recurrence and even resection in few designated cases.
迄今为止，尚无证据表明，对胃食管腺癌手术后进行更强化的随访会改善生存。本研究旨在评估由专门中心进行标准化监测对生存的影响。
分析了在我院接受胃食管腺癌根治性手术的 587 例患者的数据。根据术后随访情况，患者被分配到国家肿瘤中心进行标准化随访（SFU 组）或由其他医生进行个体化随访（非 SFU 组）。采用倾向评分匹配（PSM）来补偿组间的异质性。在 PSM 前后，比较两组的临床病理特征、复发情况以及对生存的影响。
587 例患者中，32.7%在 SFU 组，67.3%在非 SFU 组。39.4%的患者发生复发，92.6%的复发发生在术后 3 年内；73.6%的患者接受了治疗，其中 17.1%接受了手术切除。在所有复发患者和复发后生存（OS/PRS）中，诊断工具（p<0.05）、治疗（p≤0.001）和复发切除（p≤0.001）均有影响。匹配分析显示，标准化随访显著改善了 OS（84.9 与 38.4 个月，p=0.040），且在 PSM 前后均为 OS 的独立正预测因素（p=0.034/0.013）。
在 PSM 后，由专门中心进行标准化随访显著改善了 OS。横断面成像和对复发的治疗与更好的结局相关。国家指南应推荐定期进行横断面成像随访，尤其是在术后 3 年内，因为早期发现可能有助于选择接受复发治疗甚至在少数特定情况下接受手术切除的患者。
