Primary staging and follow-up in melanoma patients--monocenter evaluation of methods, costs and patient survival.
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.
Hofmann
U
U
Skin Cancer Unit (German Cancer Research Centre), University Hospital Mannheim, Theodor Kutzer Ufer 1, Mannheim 68167, Germany.
Szedlak
M
M
Rittgen
W
W
Jung
E G
EG
Schadendorf
D
D
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000191:economics / Q000379:methods*; D010808:Physical Examination; D013902:Radiography, Thoracic / Q000191:economics; D011877:Radionuclide Imaging / Q000191:economics; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000191:economics; D014463:Ultrasonography / Q000191:economics