恶性淋巴瘤患者不同随访方式发现首次复发的效率

Efficacy analysis of different follow-up methods in detecting first recurrence of lymphoma

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〉8cm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。

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 oecurred 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 em 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.