随访在结直肠癌局部复发管理中的作用：一项前瞻性随机研究。
Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study.
作者信息
Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A
机构信息
Institute of General Surgery, University of Parma, School of Medicine, Italy.
出版信息
Dis Colon Rectum. 1998 Sep;41(9):1127-33. doi: 10.1007/BF02239434.
PURPOSE
This prospective, randomized, single-center study was designed to evaluate the influence of follow-up on detection and resectability of local recurrences and on survival after radical surgery for colorectal cancer.
METHODS
Between 1987 and 1990, 207 consecutive patients who underwent curative resections for primary untreated large-bowel carcinoma were randomly assigned to a conventional follow-up group (Group A; n = 103) and to an intense follow-up group (Group B; n = 104). All the patients were followed up prospectively, and the outcome was known for all of them at five years. Patients in Group A were seen at six-month intervals for one year, and once a year thereafter. Patients in Group B were checked every three months during the first two years, at six-month intervals for the next three years, and once a year thereafter.
RESULTS
Of the 103 patients in Group A, local recurrence was detected in 20; 9 (13 percent) of these patients had colon cancer, and 11 (29 percent) had rectal cancer. Of the 104 patients in Group B, local recurrence was detected in 26; 12 (16 percent) of these patients had colon cancer, and 14 (45 percent) had rectal cancer. Twelve cases (60 percent) of local recurrence in Group A and 24 cases (92 percent) in Group B were detected at scheduled visits (P < 0.05). Local recurrences were detected earlier in patients of Group B (10.3 +/- 2.7 vs. 20.2 +/- 6.1 months; P < 0.0003). Curative re-resection was possible in 2 patients (10 percent) in Group A, 1 with colon cancer and 1 with rectal cancer, and in 17 patients (65 percent) in Group B, 6 with colon cancer and 11 with rectal cancer (P < 0.01). Of the Group B patients who had curative re-resections of local recurrence, 8 (47 percent) were disease-free and long-term survivors as of the last follow-up, and 2 (11.7 percent) were alive, but with a new recurrence. The 2 patients in Group A who had curative re-resections died as a result of cancer. The five-year survival rate in Group A was 58.3 percent and in Group B was 73.1 percent. The difference is statistically significant (P < 0.02).
CONCLUSIONS
Our data support use of an intense follow-up plan after primary resection of large-bowel cancer, at least in patients with rectal cancer.
目的
本前瞻性、随机、单中心研究旨在评估随访对结直肠癌根治术后局部复发的检测、可切除性及生存的影响。
方法
1987年至1990年间，207例连续接受原发性未治疗的大肠癌根治性切除术的患者被随机分为传统随访组（A组；n = 103）和强化随访组（B组；n = 104）。所有患者均进行前瞻性随访，5年后所有患者的结局均已知。A组患者在1年内每6个月随访1次，此后每年随访1次。B组患者在最初2年内每3个月检查1次，接下来3年内每6个月检查1次，此后每年检查1次。
结果
A组103例患者中，20例检测到局部复发；其中9例（13%）为结肠癌，11例（29%）为直肠癌。B组104例患者中，26例检测到局部复发；其中12例（16%）为结肠癌，14例（45%）为直肠癌。A组12例（60%）局部复发和B组24例（92%）局部复发在定期随访时被检测到（P < 0.05）。B组患者局部复发检测更早（10.3±2.7个月对20.2±6.1个月；P < 0.0003）。A组2例患者（10%）可行根治性再次切除，1例结肠癌，1例直肠癌；B组17例患者（65%）可行根治性再次切除，6例结肠癌，11例直肠癌（P < 0.01）。B组接受局部复发根治性再次切除的患者中，截至最后随访时，8例（47%）无病且为长期生存者，2例（11.7%）存活，但有新的复发。A组2例接受根治性再次切除的患者死于癌症。A组5年生存率为58.3%，B组为73.1%。差异具有统计学意义（P < 0.02）。
结论
我们的数据支持在大肠癌初次切除术后采用强化随访计划，至少对于直肠癌患者。
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