Imoto S, Jitsuiki Y
Division of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Jpn J Clin Oncol. 1998 Oct;28(10):597-600. doi: 10.1093/jjco/28.10.597.
Breast cancer patients are routinely followed after primary treatment. Many intensive diagnostic methods (tumor markers, chest X-ray, mammography, liver echography, bone scans) are performed periodically. However, it remains to be determined how often attempts should be made to detect the first recurrence of breast cancer by these methods.
To evaluate the effect of imaging diagnosis and tumor markers, we analyzed methods of detection of first recurrence sites during intensive follow-up of breast cancer patients.
Of 550 female patients who had been surgically treated between July 1992 and December 1996, 65 recurrent cases had been diagnosed as of December 1997. Thirty cases (46%) had been found as a result of symptoms related to the site of recurrence and 14 cases (22%) were detected by physical examination. In the remaining 21 cases (32%), detection was by other methods: in eight cases by imaging diagnosis, in three cases based on abnormal tumor markers and in 10 cases by imaging diagnosis and abnormal tumor markers. Twenty-nine cases (45%) followed every 1-3 months had presented with symptoms at routine or interval appointments. There was a significant difference between first recurrence sites (loco-regional, bone and viscera) and the methods of detection (symptoms, physical examination and other diagnostic methods) (P < 0.0001). However, no statistical difference in overall survival after operation was observed between the 30 cases found as a result of symptoms and the 35 cases detected by physical examination or other diagnostic methods.
Taken together with ASCO's surveillance guidelines (J Clin Oncol 1997;15:2149-56), intensive follow-up of breast cancer patients should be limited to high-risk breast cancer patients, especially those who enter randomized clinical trials. A careful history and physical examination are in practice indicated every 3-6 months for 3 years and then every 6 months for the following 2 years.
乳腺癌患者在接受初始治疗后需定期随访。许多强化诊断方法（肿瘤标志物、胸部X线、乳腺钼靶、肝脏超声、骨扫描）会定期进行。然而，通过这些方法检测乳腺癌首次复发的频率仍有待确定。
为评估影像诊断和肿瘤标志物的效果，我们分析了乳腺癌患者强化随访期间首次复发部位的检测方法。
在1992年7月至1996年12月接受手术治疗的550例女性患者中，截至1997年12月，已诊断出65例复发病例。30例（46%）是因复发部位相关症状而被发现，14例（22%）通过体格检查发现。其余21例（32%）通过其他方法检测到：8例通过影像诊断，3例基于肿瘤标志物异常，10例通过影像诊断和肿瘤标志物异常。每1 - 3个月随访一次的29例（45%）在常规或定期就诊时出现了症状。首次复发部位（局部区域、骨和内脏）与检测方法（症状、体格检查和其他诊断方法）之间存在显著差异（P < 0.0001）。然而，因症状发现的30例与通过体格检查或其他诊断方法检测到的35例患者术后总生存率无统计学差异。
结合美国临床肿瘤学会的监测指南（《临床肿瘤学杂志》1997年；15：2149 - 56），乳腺癌患者的强化随访应限于高危乳腺癌患者，尤其是那些参加随机临床试验的患者。实际上，建议在3年内每3 - 6个月进行一次详细的病史询问和体格检查，随后2年每6个月进行一次。
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