Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, 2200 Eglinton Ave West, Mississauga, Ontario L5M 7S4, Canada.
Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), 711 Concession Street, Hamilton, Ontario, L8V 1C3, Canada.
Surg Oncol. 2024 Jun;54:102077. doi: 10.1016/j.suronc.2024.102077. Epub 2024 Apr 10.
Appropriate surveillance of patients with melanoma treated with curative intent is vital to improve patient outcomes. A systematic review was conducted to capture locoregional recurrence and metastatic disease, and to evaluate the effectiveness of various surveillance strategies.
MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and National Cancer Institute Clinical Trials Database were searched. Randomized controlled trials (RCTs) and comparative studies reporting at least one patient-related outcome were included. Exclusion criteria included: published in non-English or recruited >20 % or an uncertain percentage of non-target patients without conducting a subgroup analysis for the target patients. This review was registered at PROSPERO (CRD42021246482).
Among 17,978 publications from the literature search, one RCT and five non-randomized comparative studies were included and comprised 4016 patients. The aggregate evidence certainty was low for the RCT and very low for the comparative studies, as assessed by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For patients with stage IA-IIC melanoma, a reduced follow-up schedule with clinical follow-up strategies alone may be safe and cost-effective. For stage IIC-IIIC patients, at least two serial PET/CT or whole-body CT and brain MRI imaging within a median follow-up of 31.2 months may detect 50 % of recurrences that lead to additional management, such as surgery. PET/CT may have a higher positive predictive value and lower false positive rate compared with CT alone in detecting recurrence in stage I-III patients.
Surveillance protocols should be based on individual risk of recurrence and established best practices when formulating follow-up strategies, as suggested by the studies reviewed. Future high-quality studies are needed to clarify the frequency of imaging follow-up strategies, especially in patients with high-risk stage II melanoma.
对接受根治性治疗的黑色素瘤患者进行适当的监测对于改善患者预后至关重要。本系统评价旨在捕获局部区域复发和转移性疾病，并评估各种监测策略的有效性。
检索 MEDLINE、EMBASE、PubMed、Cochrane 系统评价数据库和美国国立癌症研究所临床试验数据库。纳入至少报告一项患者相关结局的随机对照试验（RCT）和比较研究。排除标准包括：发表于非英文期刊，或纳入≥20%或不确定百分比的非目标患者，且未对目标患者进行亚组分析。本综述在 PROSPERO（CRD42021246482）注册。
从文献检索中得到 17978 篇文献，纳入了 1 项 RCT 和 5 项非随机比较研究，共包含 4016 例患者。根据 GRADE（推荐分级的评估、制定与评价）方法评估，RCT 的综合证据确定性为低，比较研究的证据确定性为极低。对于 IA-IIC 期黑色素瘤患者，单独采用临床随访策略的减少随访方案可能是安全且具有成本效益的。对于 IIC-III 期患者，在中位随访 31.2 个月内至少进行两次连续的 PET/CT 或全身 CT 和脑 MRI 成像可能会发现 50%导致进一步治疗（如手术）的复发。与单独 CT 相比，PET/CT 可能在检测 I-III 期患者的复发方面具有更高的阳性预测值和更低的假阳性率。
在制定随访策略时，应根据个体复发风险和既定的最佳实践来选择监测方案，正如本研究综述所建议的那样。需要开展高质量的未来研究来明确影像学随访策略的频率，尤其是在高危 II 期黑色素瘤患者中。
