Impact of early detection on cancer curability: A modified Delphi panel study.
Impact of early detection on cancer curability: A modified Delphi panel study.
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早期检测对癌症可疗法的影响：一项改进的Delphi小组研究。
DOI：
10.1371/journal.pone.0279227
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Yermilov, Irina
中科院分区：
文献类型：
--
作者：
Schwartzberg, Lee;Broder, Michael S.;Ailawadhi, Sikander;Beltran, Himisha;Blakely, L. Johnetta;Budd, G. Thomas;Carr, Laurie;Cecchini, Michael;Cobb, Patrick;Kansal, Anuraag;Kim, Ashley;Monk, Bradley J.;Wong, Deborah J.;Campos, Cynthia;Yermilov, Irina
专家们对早期癌症检测的潜在益处并没有达成共识，这对大多数癌症类型来说都是不存在的。我们召集了10名执业肿瘤学家，使用兰德/加州大学洛杉矶分校修改的德尔菲小组来评估20种实体肿瘤中的哪一种能从早期检测中获得潜在的临床益处，这些实体肿瘤代表了美国癌症联合委员会（AJCC）确定的40种癌症类型和总癌症发病率的80%。会前，专家们估计了癌症进展所需的时间，并对每年假设的多种癌症筛查血液测试的当前可治愈性和益处（可治愈性的改善）进行了评估。会后，专家们再次提出了所有问题。根据对癌症的可治愈性和分期进展的估计，对早期癌症检测的潜在益处有不同的估计。据估计，进展迅速且在早期阶段可治愈的癌症（胃癌、食道癌、肺癌、尿路上皮癌、黑色素瘤、卵巢癌、肉瘤、膀胱癌、子宫颈癌、乳腺癌、结肠/直肠癌、肾癌、子宫癌、肛门癌、头颈癌）最有可能从假设的筛查血液测试中受益。被评为进展迅速但在早期阶段治愈率相对较低的癌症类型（肝脏/肝内胆管、胆囊、胰腺）估计从假设的筛查血液测试中获益的可能性中等。据估计，进展较慢且不论分期都具有较高治愈率的癌症类型（前列腺癌、甲状腺癌）从假设的筛查血液测试中获益的可能性有限。该小组得出结论，大多数实体瘤都有可能从早期发现中获益。即使在难以治疗的癌症（如胰腺、肝脏/肝内胆管、胆囊）中，早期检测也被认为是有益的。根据专家小组的共识，通过筛查血液测试来广泛覆盖癌症将为患者带来最大的潜在益处。
Expert consensus on the potential benefits of early cancer detection does not exist for most cancer types. We convened 10 practicing oncologists using a RAND/UCLA modified Delphi panel to evaluate which of 20 solid tumors, representing >40 American Joint Committee on Cancer (AJCC)-identified cancer types and 80% of total cancer incidence, would receive potential clinical benefits from early detection. Pre-meeting, experts estimated how long cancers take to progress and rated the current curability and benefit (improvement in curability) of an annual hypothetical multi-cancer screening blood test. Post-meeting, experts rerated all questions. Cancers had varying estimates of the potential benefit of early cancer detection depending on estimates of their curability and progression by stage. Cancers rated as progressing quickly and being curable in earlier stages (stomach, esophagus, lung, urothelial tract, melanoma, ovary, sarcoma, bladder, cervix, breast, colon/rectum, kidney, uterus, anus, head and neck) were estimated to be most likely to benefit from a hypothetical screening blood test. Cancer types rated as progressing quickly but having comparatively lower cure rates in earlier stages (liver/intrahepatic bile duct, gallbladder, pancreas) were estimated to have medium likelihood of benefit from a hypothetical screening blood test. Cancer types rated as progressing more slowly and having higher curability regardless of stage (prostate, thyroid) were estimated to have limited likelihood of benefit from a hypothetical screening blood test. The panel concluded most solid tumors have a likelihood of benefit from early detection. Even among difficult-to-treat cancers (e.g., pancreas, liver/intrahepatic bile duct, gallbladder), early-stage detection was believed to be beneficial. Based on the panel consensus, broad coverage of cancers by screening blood tests would deliver the greatest potential benefits to patients.
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