Gulliford M C, Petruckevitch A, Burney P G
Department of Public Health Medicine, United Medical School, Guy's Hospital, London.
Ann R Coll Surg Engl. 1993 Jan;75(1):57-61.
This study evaluated the efficiency with which follow-up cystoscopy was employed in a population-based cohort of patients with superficial bladder cancer. Subjects were 240 men, aged under 75 years, with superficial bladder cancer first diagnosed in 1982. The median duration of follow-up was 6.1 years. The median (interquartile range) number of follow-up cystoscopies was 8 (5-12) per patient with a patient-specific annual rate of 1.7 (1.2-2.2) per year. The median number of cystoscopies at which recurrent tumour was detected was 2 (0-5) per patient, patient-specific annual rate 0.4 (0.0-1.3) per year of follow-up. Among patients with a single tumour at diagnosis and a negative first check cystoscopy (MRC group 1), the proportion of positive cystoscopies was 0.1 (0.0-0.4). Comparison of observed intervals between cystoscopies with optimal intervals calculated using an optimisation model showed that patients in MRC group 1 were seen sooner in practice than the model predicted, while in practice other patients were seen later than the model predicted. These data support the suggestion that efficiency of follow-up for patients with superficial bladder cancer could be increased by dividing patients into groups with different risks of recurrence and differing follow-up requirements.
本研究评估了在一个基于人群的浅表性膀胱癌患者队列中采用随访膀胱镜检查的效率。研究对象为240名年龄在75岁以下、于1982年首次被诊断为浅表性膀胱癌的男性患者。随访的中位时长为6.1年。每位患者随访膀胱镜检查的中位（四分位间距）次数为8次（5 - 12次），患者个体的年检查率为每年1.7次（1.2 - 2.2次）。检测到复发性肿瘤时膀胱镜检查的中位次数为每位患者2次（0 - 5次），患者个体每年随访的检查率为0.4次（0.0 - 1.3次）。在诊断时为单一肿瘤且首次膀胱镜检查结果为阴性的患者（MRC第1组）中，膀胱镜检查呈阳性的比例为0.1（0.0 - 0.4）。将实际膀胱镜检查间隔时间与使用优化模型计算出的最佳间隔时间进行比较，结果显示，MRC第1组患者在实际中接受检查的时间比模型预测的要早，而其他患者在实际中接受检查的时间比模型预测的要晚。这些数据支持了以下建议，即通过将患者分为复发风险不同且随访要求各异的组，可以提高浅表性膀胱癌患者随访的效率。
