A novel hypothesis on the sensitivity of the fecal occult blood test: Results of a joint analysis of 3 randomized controlled trials.
A novel hypothesis on the sensitivity of the fecal occult blood test: Results of a joint analysis of 3 randomized controlled trials.
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DOI：
10.1002/cncr.24256
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发表时间：
2009-06-01
期刊：
影响因子：
6.2
通讯作者：
Habbema, J. Dik F.
中科院分区：
文献类型：
--
作者：
Lansdorp-Vogelaar, Iris;van Ballegooijen, Marjolein;Boer, Rob;Zauber, Ann;Habbema, J. Dik F.
筛查试验之间对粪便隐血试验（FOBT）（Hemoccult II）敏感性的估计差异很大，这将导致对FOBT筛查效果的不同结论。我们使用微观模拟模型来评估临床前结直肠癌（CRC）的持续时间和对来自明尼苏达州、诺丁汉和Funen的3项随机对照试验数据的未水合FOBT的敏感性。除了两个常见的假设FOBT的敏感性，我们测试了一个新的假设，敏感性与临床诊断阶段的情况下，没有筛选。我们使用MISCAN-Colon微观模拟模型来估计敏感性和持续时间，解释了试验在人口统计学、背景发病率和试验设计方面的差异。我们测试了FOBT敏感性的三个假设：所有临床前CRC阶段的敏感性是相同的，敏感性随着每个阶段的增加而增加，并且在没有筛查的情况下诊断癌症的阶段的敏感性高于早期阶段。通过比较预期和观察到的筛查检出率和间期CRC率，评价拟合优度。在临床诊断阶段具有较高灵敏度的假设给出了最佳拟合。在此假设下，FOBT在临床诊断阶段的敏感性为51%，在早期阶段的敏感性为19%。临床前CRC的平均持续时间估计为6.7年。我们的分析证实了临床前CRC的持续时间较长，FOBT在临床诊断阶段最敏感。
Estimates of the fecal occult blood test (FOBT) (Hemoccult II) sensitivity differ widely between screening trials, and will lead to divergent conclusions on the effects of FOBT screening. We used microsimulation modeling to estimate a preclinical colorectal cancer (CRC) duration and sensitivity for unrehydrated FOBT from the data of 3 randomized controlled trials of Minnesota, Nottingham and Funen. In addition to two usual hypotheses on the sensitivity of FOBT, we tested a novel hypothesis where sensitivity is linked to the stage of clinical diagnosis in the situation without screening. We used the MISCAN-Colon microsimulation model to estimate sensitivity and duration, accounting for differences between the trials in demography, background incidence and trial design. We tested three hypotheses for FOBT sensitivity: sensitivity is the same for all preclinical CRC stages, sensitivity increases with each stage, and sensitivity is higher for the stage in which the cancer would have been diagnosed in the absence of screening than for earlier stages. Goodness of fit was evaluated by comparing expected and observed rates of screen-detected and interval CRC. The hypothesis with a higher sensitivity in the stage of clinical diagnosis gave the best fit. Under this hypothesis, sensitivity of FOBT was 51% in the stage of clinical diagnosis and 19% in earlier stages. The average duration of preclinical CRC was estimated at 6.7 years. Our analysis corroborates a long duration of preclinical CRC, with FOBT most sensitive in the stage of clinical diagnosis.
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DOI：
10.1111/j.1445-2197.1991.tb00190.x
发表时间：
1991-02-01
期刊：
AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY
影响因子：
--
作者：
KYLE, SM;ISBISTER, WH;YEONG, ML
通讯作者：
YEONG, ML
影响因子：
--
作者：
Levin, B;Hess, K;Johnson, C
通讯作者：
Johnson, C
影响因子：
6.2
作者：
MUTO, T;BUSSEY, HJR;MORSON, BC
通讯作者：
MORSON, BC
影响因子：
254.7
作者：
Parkin, DM;Bray, F;Pisani, P
通讯作者：
Pisani, P
影响因子：
7.7
作者：
Moss, SM;Hardcastle, JD;Rodrigues, VC
通讯作者：
Rodrigues, VC