Limits...
Primary staging and follow-up in melanoma patients--monocenter evaluation of methods, costs and patient survival.

Hofmann U, Szedlak M, Rittgen W, Jung EG, Schadendorf D - Br. J. Cancer (2002)

Bottom Line: Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III.The mode of detecting a relapse ('patient vs. doctor-diagnosed' or 'symptomatic vs asymptomatic') did not significantly influence patients overall survival.Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient.

View Article: PubMed Central - PubMed

Affiliation: Skin Cancer Unit (German Cancer Research Centre), University Hospital Mannheim, Theodor Kutzer Ufer 1, Mannheim 68167, Germany.

ABSTRACT
In a German cohort of 661 melanoma patients the performance, costs and survival benefits of staging methods (history and physical examination; chest X-ray; ultrasonography of the abdomen; high resolution sonography of the peripheral lymph nodes) were assessed at initial staging and during follow-up of stage I/II+III disease. At initial staging, 74% (23 out of 31) of synchronous metastases were first detected by physical examination followed by sonography of the lymph nodes revealing 16% (5 out of 31). Other imaging methods were less efficient (Chest X-ray: one out of 31; sonography of abdomen: two out of 31). Nearly 24% of all 127 first recurrences and 18% of 73 second recurrences developed in patients not participating in the follow-up programme. In follow-up patients detection of first or second recurrence were attributed to history and physical examination on a routine visit in 47 and 52% recurrences, respectively, and to routine imaging procedures in 21 and 17% of cases, respectively. Lymph node sonography was the most successful technical staging procedure indicating 13% of first relapses, but comprised 24% of total costs of follow-up in stage I/II. Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III. The mode of detecting a relapse ('patient vs. doctor-diagnosed' or 'symptomatic vs asymptomatic') did not significantly influence patients overall survival. Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient.

Show MeSH

Related in: MedlinePlus

Distribution pattern of 127 first recurrences in 630 FU I/II patients. The recurrence pattern was classified into local (satellites or in-transit metastases), regional (regional lymph nodes), distant (viscera; distant (sub-)cutis or lymph nodes) or combinations of these locations.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2376106&req=5

fig2: Distribution pattern of 127 first recurrences in 630 FU I/II patients. The recurrence pattern was classified into local (satellites or in-transit metastases), regional (regional lymph nodes), distant (viscera; distant (sub-)cutis or lymph nodes) or combinations of these locations.

Mentions: Number of documented initial staging tests performed at the time of primary diagnosis.


Primary staging and follow-up in melanoma patients--monocenter evaluation of methods, costs and patient survival.

Hofmann U, Szedlak M, Rittgen W, Jung EG, Schadendorf D - Br. J. Cancer (2002)

Distribution pattern of 127 first recurrences in 630 FU I/II patients. The recurrence pattern was classified into local (satellites or in-transit metastases), regional (regional lymph nodes), distant (viscera; distant (sub-)cutis or lymph nodes) or combinations of these locations.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2376106&req=5

fig2: Distribution pattern of 127 first recurrences in 630 FU I/II patients. The recurrence pattern was classified into local (satellites or in-transit metastases), regional (regional lymph nodes), distant (viscera; distant (sub-)cutis or lymph nodes) or combinations of these locations.
Mentions: Number of documented initial staging tests performed at the time of primary diagnosis.

Bottom Line: Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III.The mode of detecting a relapse ('patient vs. doctor-diagnosed' or 'symptomatic vs asymptomatic') did not significantly influence patients overall survival.Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient.

View Article: PubMed Central - PubMed

Affiliation: Skin Cancer Unit (German Cancer Research Centre), University Hospital Mannheim, Theodor Kutzer Ufer 1, Mannheim 68167, Germany.

ABSTRACT
In a German cohort of 661 melanoma patients the performance, costs and survival benefits of staging methods (history and physical examination; chest X-ray; ultrasonography of the abdomen; high resolution sonography of the peripheral lymph nodes) were assessed at initial staging and during follow-up of stage I/II+III disease. At initial staging, 74% (23 out of 31) of synchronous metastases were first detected by physical examination followed by sonography of the lymph nodes revealing 16% (5 out of 31). Other imaging methods were less efficient (Chest X-ray: one out of 31; sonography of abdomen: two out of 31). Nearly 24% of all 127 first recurrences and 18% of 73 second recurrences developed in patients not participating in the follow-up programme. In follow-up patients detection of first or second recurrence were attributed to history and physical examination on a routine visit in 47 and 52% recurrences, respectively, and to routine imaging procedures in 21 and 17% of cases, respectively. Lymph node sonography was the most successful technical staging procedure indicating 13% of first relapses, but comprised 24% of total costs of follow-up in stage I/II. Routine imaging comprised nearly 50% of total costs for follow-up in stage I/II and in stage III. The mode of detecting a relapse ('patient vs. doctor-diagnosed' or 'symptomatic vs asymptomatic') did not significantly influence patients overall survival. Taken together, imaging procedures for routine follow-up in stage I/II and stage III melanoma patients were inefficient and not cost-efficient.

Show MeSH
Related in: MedlinePlus