Joseph E, Hyacinthe M, Lyman G H, Busch C, Demps L, Reintgen D S, Cox C E
Comprehensive Breast Cancer Program, Moffitt Cancer Center, University of South Florida, Tampa 33612, USA.
Ann Surg Oncol. 1998 Sep;5(6):522-8. doi: 10.1007/BF02303645.
Controversies over the frequency and intensity of the follow-up care of breast cancer patients exist. Some physicians have adopted an intensive approach to follow-up care that consists of frequent laboratory tests and routine imaging studies, including chest radiographs, bone scans, and CT scans, whereas others have established a minimalist approach consisting of only history, physical examinations, and mammograms.
Our objective was to evaluate the role of intensive follow-up on detection of breast cancer recurrence and to examine the impact of follow-up on overall survival.
During a 10-year period (1986-1996), 129 patients with recurrent disease were identified from a prospective database of 1898 breast cancer patients. The patients with recurrent disease were divided into minimalist or intensive groups according to method of detection.
Twenty-seven of 126 (21%) patients were assigned to the intensive method of detection group (LFT, CEA, CA 15-3, chest radiograph, CT scan, and bone scan); 99 of 126 (79%) patients were assigned to the minimal detection group (history, physical examination, and mammography). Distant disease to the bone was the most common initial tumor recurrence, at 27%. History, physical examination, and mammography detected recurrent cancer in approximately the same amount of time as LFTs, tumor markers, CT scans, and chest radiographs (P = .960). When the recurrent patients were divided into intensive and minimalist groups and analyzed by time to detection of recurrence, there was no significant difference between the time to detection in those recurrences detected by intensive methods and those recurrences detected by minimalist methods (P = .95). The independent variables age, tumor size, type of surgery, number of positive nodes, time to recurrence, method of detection, and site of recurrence (regional or distant) were subject to univariate and multivariate analysis by the Cox proportional hazards model. Only two variables had an impact on survival by multivariate analysis: early timing of the recurrence (P = .0011) and the site of the recurrence (P = .02). Timing was defined as early (< or =365 days from the time of diagnosis to recurrence) or late (> or =365 days from the time of diagnosis to recurrence). Early recurrence was the first variable found to be significant on stepwise forward regression analysis. The primary site of recurrence was significant at step two. The method of detection--intensive or minimal--did not significantly affect survival (P = .18).
There is no survival benefit to routine intensive follow-up regimens in detecting recurrent breast cancer. Expensive diagnostic tests such as bone scans, CT scans, and serial tumor markers are best used for detection of metastasis in symptomatic patients.
乳腺癌患者后续护理的频率和强度存在争议。一些医生采用强化后续护理方法，包括频繁的实验室检查和常规影像学检查，如胸部X光、骨扫描和CT扫描；而另一些医生则采用极简主义方法，仅包括病史、体格检查和乳房X光检查。
我们的目的是评估强化随访在检测乳腺癌复发中的作用，并研究随访对总生存期的影响。
在10年期间（1986 - 1996年），从1898例乳腺癌患者的前瞻性数据库中识别出129例复发疾病患者。根据检测方法，将复发疾病患者分为极简主义组或强化组。
126例患者中有27例（21%）被分配到强化检测方法组（肝功能检查、癌胚抗原、糖类抗原15 - 3、胸部X光、CT扫描和骨扫描）；126例患者中有99例（79%）被分配到极简检测组（病史、体格检查和乳房X光检查）。骨远处转移是最常见的初始肿瘤复发，占27%。病史、体格检查和乳房X光检查检测到复发癌的时间与肝功能检查、肿瘤标志物、CT扫描和胸部X光检查大致相同（P = 0.960）。当将复发患者分为强化组和极简主义组，并按复发检测时间进行分析时，强化方法检测到的复发与极简主义方法检测到的复发在检测时间上没有显著差异（P = 0.95）。通过Cox比例风险模型对年龄、肿瘤大小、手术类型、阳性淋巴结数量、复发时间、检测方法和复发部位（局部或远处）等自变量进行单变量和多变量分析。多变量分析中只有两个变量对生存有影响：复发的早期时间（P = 0.0011）和复发部位（P = 0.02）。时间定义为早期（从诊断到复发≤365天）或晚期（从诊断到复发≥365天）。早期复发是逐步向前回归分析中第一个被发现具有显著性的变量。复发的主要部位在第二步具有显著性。检测方法——强化或极简——对生存没有显著影响（P = 0.18）。
常规强化随访方案在检测复发性乳腺癌方面没有生存益处。骨扫描、CT扫描和系列肿瘤标志物等昂贵的诊断测试最好用于有症状患者的转移检测。
