Naunheim K S, Virgo K S, Coplin M A, Johnson F E
Department of Surgery, Saint Louis University Health Sciences Center, Missouri 63110-0250, USA.
Ann Thorac Surg. 1995 Dec;60(6):1612-6. doi: 10.1016/0003-4975(95)00762-8.
Although routine clinical surveillance testing after lung cancer operation has important clinical implications for patients and financial implications for society, the ideal surveillance strategy is unknown.
We surveyed The Society of Thoracic Surgeons membership by questionnaire to characterize the current practice of follow-up among experts in lung cancer treatment. There were 2,009 responses (54% return) from the 3,700 members; 768 of those responding both operate on and provide long-term follow-up for lung cancer patients. These responses form the basis of this study.
The follow-up methods most frequently used during a 5-year follow-up include clinic visit, chest roentgenography, complete blood cell count, liver function testing, and chest computed tomography. Sputum cytology, head computed tomography, bone scanning, chest magnetic resonance imaging, and bronchoscopy are used infrequently. Although there is wide variation in the frequency of use of these ten methods, there is significant (p < 0.05) decrease in the frequency of testing over time for all tests except sputum cytology and chest magnetic resonance imaging. The survey also requested information regarding motivation behind routine clinical surveillance testing. Although the presumed rationale for such follow-up includes probable clinical benefit for the patient, fewer than half of respondents believe that such surveillance testing would yield a survival benefit for either stage I (44% of respondents) or advanced-stage patients (17% of respondents) after lung cancer resection. Only 1 of 4 respondents believe that the current literature documents any survival benefit. Other reasons for follow-up include maintenance of rapport with colleagues or patients and medicolegal liability concerns.
This survey provides direct evidence regarding current surveillance practice among thoracic surgeons. There appears to be marked variation among members of The Society of Thoracic Surgeons in frequency of and rationale for routine clinical surveillance testing.
尽管肺癌手术后的常规临床监测检查对患者具有重要临床意义，对社会具有经济意义，但理想的监测策略尚不清楚。
我们通过问卷调查了胸外科医师协会的成员，以了解肺癌治疗专家目前的随访实践情况。3700名成员中有2009人回复（回复率54%）；其中768人既为肺癌患者进行手术，又提供长期随访。这些回复构成了本研究的基础。
在5年随访期间最常使用的随访方法包括门诊就诊、胸部X线检查、全血细胞计数、肝功能检查和胸部计算机断层扫描。痰细胞学检查、头部计算机断层扫描、骨扫描、胸部磁共振成像和支气管镜检查使用较少。尽管这十种方法的使用频率差异很大，但除痰细胞学检查和胸部磁共振成像外，所有检查的检测频率随时间均有显著（p < 0.05）下降。该调查还询问了常规临床监测检查背后的动机信息。尽管这种随访的假定基本原理包括可能对患者有临床益处，但不到一半的受访者认为这种监测检查会给肺癌切除术后的I期患者（44%的受访者）或晚期患者（17%的受访者）带来生存益处。只有四分之一的受访者认为当前文献记录了任何生存益处。随访的其他原因包括与同事或患者保持融洽关系以及医疗法律责任问题。
这项调查提供了关于胸外科医生当前监测实践的直接证据。胸外科医师协会成员在常规临床监测检查的频率和基本原理方面似乎存在显著差异。
