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Identification of relapse predictors may be useful to design effective early intervention strategies for relapse of susceptible patients with bulimia nervosa.This multisite study examined relapse in 48 patients with bulimia nervosa who had responded to cognitive behavioral therapy with complete abstinence from binge eating and purging.
The ROC analysis of SUVmax reduction at interim for identification of relapse patients showed an AUC of 0.58 (p = 0.684) with a corresponding optimal cutoff value at 90.5%.
On the other hand, our series demonstrates that the routine use of the CT scan is both costly and of little value in the identification of relapse.
Upfront identification of relapse patients based on prognostic markers including molecular minimal residual disease is hampered by the fact that the majority of patients encountering relapse are not recognized by these markers and are initially assigned to non-high-risk therapy regimens.
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Although it has been become clear that CTCs are a powerful marker for the prediction of early metastatic disease, not many studies have specifically addressed the use of CTCs for the identification of late relapse and this area of research needs further investigation.
The previously mentioned patient with histologically proven carcinoma in situ obtained from biopsy taken under local anesthesia, which subsequently underwent the cordectomy from the external approach with negative histology, was still considered a positive identification of the relapse of the disease and was rated as one of the TP.
While some have advocated fewer follow-up visits and more patient education on the grounds that the identification of most relapses stem from patient-reported symptoms (Radford et al, 1997), more than half of the relapses in our series were detected through the physician's clinical assessments, radiological investigations or complete blood counts, all of which require routine visits.
The gene signatures yielded good performance at 10 years but we observed a strong degradation when considering the full follow-up due to the poor identification of late relapses (after 10 years).
The cost per identification of a true relapse was US $6000.
Thus, the objectives of our study were to: [ 1] assess the incremental diagnostic performance and the impact on therapeutic management of F-FDG PET/CT in a group of patients with a history of BC who had already been restaged by CI for identification of suspected disease relapse; [ 2] compare the long-term prognostic stratification of CI alone and F-FDG PET/CT.
Consequently, through multiple blood sampling, this study emphasised that persistent postoperative CTCs (lasting for 4 weeks postoperatively) might have a role in the early identification of postoperative early relapse in colon cancer patients, and more intensive therapies may be considered among these patients.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com