CAJ | 학술논문

目的比较初治淋巴瘤患者获得完全缓解后不同的复查方式是否影响对肿瘤复发的及时诊断,探讨合理的长期随访策略.方法回顾性分析经初始治疗后达到完全缓解并出现首次复发的277例淋巴瘤患者的临床及随访资料,根据其治疗后复查方式将所有患者分为规律影像学复查组(A组)和不规律影像学复查组(B组).比较复发时两组患者的肿瘤最大径和肿瘤侵犯区域数量,比较两组患者至复发时的影像学检查次数.分析两组患者首次发现复发的主要方式.结果 A组187例,B组90例.277例患者第1年内复发120例,占43.3％;第2年复发76例,占27.4％.复发时A组和B组患者的肿瘤最大径分别为(3.2 ±2.2)cm和(3.8±2.9)cm,差异无统计学意义(P=0.123).两组患者的肿瘤侵犯范围略有差异,统计学结果为临界值(P=0.050).复发时A组和B组患者中肿块＞8 cm的患者比例分别为2.5％ (3/121)和12.2％ (6/49),差异有统计学意义(P=0.018).A组和B组患者至复发时的平均影像学检查次数分别为4.9和0.2次,差异有统计学意义(P＜0.001).277例患者中,仅有59例(21.3％)患者必须依靠影像学检查才能发现复发.结论大部分淋巴瘤患者并未从规律的影像学复查中获益,提示淋巴瘤患者治疗后的随访中不宜单纯依赖影像学检查,应重视症状、体征等临床征象.
목적 비교초치림파류환자획득완전완해후불동적복사방식시부영향대종류복발적급시진단,탐토합리적장기수방책략.방법 회고성분석경초시치료후체도완전완해병출현수차복발적277례림파류환자적림상급수방자료,근거기치료후복사방식장소유환자분위규률영상학복사조(A조)화불규률영상학복사조(B조).비교복발시량조환자적종류최대경화종류침범구역수량,비교량조환자지복발시적영상학검사차수.분석량조환자수차발현복발적주요방식.결과 A조187례,B조90례.277례환자제1년내복발120례,점43.3％;제2년복발76례,점27.4％.복발시A조화B조환자적종류최대경분별위(3.2 ±2.2)cm화(3.8±2.9)cm,차이무통계학의의(P=0.123).량조환자적종류침범범위략유차이,통계학결과위림계치(P=0.050).복발시A조화B조환자중종괴＞8 cm적환자비례분별위2.5％ (3/121)화12.2％ (6/49),차이유통계학의의(P=0.018).A조화B조환자지복발시적평균영상학검사차수분별위4.9화0.2차,차이유통계학의의(P＜0.001).277례환자중,부유59례(21.3％)환자필수의고영상학검사재능발현복발.결론 대부분림파류환자병미종규률적영상학복사중획익,제시림파류환자치료후적수방중불의단순의뢰영상학검사,응중시증상、체정등림상정상.
Objective This study aimed to evaluate the value of different follow-up methods for the detection of first recurrence in lymphoma patients in first complete remission (CR),and to find reasonable long-term follow-up strategies.Methods We retrospectively analyzed 277 lymphoma patients who achieved CR after first-line therapies and subsequently relapsed.All patients were divided into routine surveillance imaging group (group A) and irregular imaging follow-up visit group (group B).To compare the two groups of patients with tumor burden (tumor diameter and number of tumor invasion areas) at the time of relapse,and the number of imaging scans before the relapse.To analyze the main ways of finding lymphoma relapse in the two groups.Results Among a total of 277 patients,there were 187 patients in the group A and 90 patients in the group B.The tumor recurrence occurred in 120 cases (43.3％) within the first year,and 76 patients (27.4％) in the second year.At the time of diagnosis of recurrence,the average maximum diameter of tumors in the groups A and B were (3.2 ± 2.2) cm and (3.8 ± 2.9) cm,respectively (P =0.123).The two groups showed slight difference in number of tumor invasion areas (P =0.050).At the time of diagnosis of recurrence,there were 3 of 121 patients (2.5％) with maximum diameter of tumors more than 8 cm in the group A and 6 of 49 cases (12.2％) in the group B (P=0.018).In the group A,the patients had in average 4.9 times of imaging scans before recurrence,significantly more than the 0.22 times in the group B (P ＜0.001).Among all patients,the diagnosis of recurrence was based on imaging scans only in 59 patients (21.3％).Conclusions Most lymphoma patients do not benefit from routine surveillance imaging to detect the tumor recurrence.It indicates that we should not rely solely on imaging examinations at follow-up visits,and should pay more attention on clinical signs and symptoms.