Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Obstetrics and Gynecology, Yale-New Haven Hospital, New Haven, Connecticut, USA.
Int J Gynecol Cancer. 2022 Feb;32(2):159-164. doi: 10.1136/ijgc-2021-002885. Epub 2021 Dec 29.
Given the inconvenience and financial burden of frequent ovarian cancer surveillance and the risks of in-person visits due to COVID-19, which have led to the acceleration of telehealth adaptation, we sought to assess the role of in-person physical examination for the detection of ovarian cancer recurrence among patients enrolled in a routine surveillance program.
This was a retrospective study of patients initially seen from January 2015 to December 2017 who experienced ovarian cancer recurrence during first clinical remission. Descriptive statistics and bivariate analyses were performed to compare differences in detection methods and in patient and disease characteristics.
Among 147 patients who met our inclusion criteria, there were no recurrences detected by physical examination alone. Forty-six (31%) patients had recurrence first detected by tumor marker, 81 (55%) by radiographic scan, 17 (12%) by presentation of new symptoms, and 3 (2%) by biopsies taken during non-oncological surgery. One hundred and eleven patients (75%) had multiple positive findings at the time of recurrence. Of all 147 patients, 48 (33%) had symptoms, 21 (14%) had physical examination findings, 106 (72%) had increases in tumor markers, and 141 (96%) had changes on imaging.
In-person physical examination was not a primary means of detection for ovarian cancer recurrence for any patient. Substituting in-person visits for virtual visits that include patient-reported symptoms, alongside a regular surveillance protocol that includes tumor marker testing and imaging, may be a suitable approach for the detection of ovarian cancer recurrence while also reducing patient inconvenience and risks to health.
鉴于频繁进行卵巢癌监测既不方便又有经济负担，且由于 COVID-19 而导致面对面就诊的风险增加，这加速了远程医疗的应用，我们旨在评估在常规监测计划中，对于接受卵巢癌监测的患者，体格检查在卵巢癌复发检测中的作用。
这是一项回顾性研究，纳入了在首次临床缓解期间复发卵巢癌的患者，这些患者最初于 2015 年 1 月至 2017 年 12 月就诊。我们进行了描述性统计和双变量分析，以比较不同检测方法以及患者和疾病特征之间的差异。
在符合纳入标准的 147 名患者中，没有单独通过体格检查发现的复发。46 名（31%）患者的复发首先通过肿瘤标志物检测发现，81 名（55%）通过影像学扫描发现，17 名（12%）通过出现新症状发现，3 名（2%）通过非肿瘤手术时的活检发现。111 名（75%）名患者在复发时存在多种阳性发现。在所有 147 名患者中，48 名（33%）有症状，21 名（14%）有体格检查发现，106 名（72%）肿瘤标志物升高，141 名（96%）影像学改变。
对于任何患者，体格检查均不是卵巢癌复发的主要检测手段。替代面对面就诊的是包括患者报告的症状在内的虚拟就诊，同时遵循包括肿瘤标志物检测和影像学检查在内的常规监测方案，可能是检测卵巢癌复发的一种合适方法，同时也减少了患者的不便和对健康的风险。
