Edelman M J, Meyers F J, Siegel D
Division of Hematology and Oncology, Veterans Affairs Northern California Health Care System, Martinez 94553, USA.
J Gen Intern Med. 1997 May;12(5):318-31. doi: 10.1046/j.1525-1497.1997.012005318.x.
To review (1) basic principles of follow-up in patients who are in complete remission following curative therapy for cancer; (2) evaluate the available data on follow-up strategies for testicular cancer, Hodgkin's disease, non-Hodgkin's lymphoma, breast cancer, colorectal cancer, small cell and non-small cell lung cancer, and prostate cancer; and (3) analyze the cost of follow-up strategies.
The English language literature was reviewed utilizing MEDLINE headings for the specific malignancies and the text word "follow-up." Bibliographies of relevant articles also were reviewed. Emphasis was placed on prospective, randomized trials of large retrospective studies in which all patients who potentially could have been evaluated were accounted. The cost of various testing strategies were analyzed utilizing data from the Health Care Finance Administration.
Proper follow-up strategies should take into account patterns and time course of recurrence and should be obtained of detection of recurrence would allow meaningful therapeutic intervention. Testing also should be directed at early detection of malignant and nonmalignant complications known to be associated with the primary disease. Testicular cancer is a "model" malignancy in that sensitive tests for recurrence are available and early detection of recurrence allows for potentially curative therapy.
According to the currently available literature, repetitive follow-up laboratory and radiologic testing, except for nonseminomatous germ cell tumors, does not detect the vast majority of cancer relapses, nor does it result in a greater chance of cure or prolonged survival. The majority of recurrences at all disease sites will first be recognized as symptomatic changes in the patient's condition or alterations in the physical examination. A limited panel of blood tests and radiographic studies to detect recurrences, metachronous disease, and complications of therapy (malignant and nonmalignant), will suffice for most cancers. Though data are limited, this more restrictive policy of follow-up testing does not appear to adversely impact patient quality of life and result in dramatic cost of savings to the health care system.
（1）回顾癌症根治性治疗后完全缓解患者的随访基本原则；（2）评估睾丸癌、霍奇金病、非霍奇金淋巴瘤、乳腺癌、结直肠癌、小细胞肺癌和非小细胞肺癌以及前列腺癌随访策略的现有数据；（3）分析随访策略的成本。
利用MEDLINE中特定恶性肿瘤的标题和“随访”文本词对英文文献进行回顾。还查阅了相关文章的参考文献。重点关注前瞻性、随机试验或大型回顾性研究，其中对所有可能接受评估的患者进行了统计。利用医疗保健财务管理局的数据对各种检测策略的成本进行分析。
恰当的随访策略应考虑复发模式和时间进程，并且检测到复发时应能进行有意义的治疗干预。检测还应针对早期发现已知与原发性疾病相关的恶性和非恶性并发症。睾丸癌是一种“典型”恶性肿瘤，因为有针对复发的敏感检测方法，且早期发现复发可进行潜在的根治性治疗。
根据现有文献，除非精原细胞性生殖细胞肿瘤外，重复性的随访实验室检查和影像学检查并不能检测到绝大多数癌症复发，也不会增加治愈机会或延长生存期。所有疾病部位的大多数复发首先会被识别为患者状况的症状性变化或体格检查的改变。对于大多数癌症，一组有限的血液检查和影像学研究足以检测复发、异时性疾病以及治疗并发症（恶性和非恶性）。尽管数据有限，但这种更具限制性的随访检测政策似乎不会对患者生活质量产生不利影响，并且能为医疗保健系统节省大量成本。
