Quantifying the potential benefits of early detection for pancreatic cancer through a counterfactual simulation modeling analysis.
Quantifying the potential benefits of early detection for pancreatic cancer through a counterfactual simulation modeling analysis.
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DOI：
10.1038/s41598-023-46751-3
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发表时间：
2023-11-16
影响因子：
4.6
通讯作者：
中科院分区：
文献类型：
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作者：
癌症早期发现的好处取决于各种因素，包括癌症类型、筛查方法性能、诊断阶段和后续治疗。虽然许多研究已经评估了筛查干预措施在早期阶段识别癌症的有效性，但还没有定量分析来研究产生最大死亡率效益的最佳早期检测时间间隔；这些数据可以作为癌症早期检测战略的目标和基准。在这项研究中，我们关注的是胰腺导管腺癌(PDAC)，这是一种以缺乏早期症状而闻名的癌症。因此，它最常在晚期发现，当时5年存活率只有3%。我们开发了一个PDAC总体模型，模拟单个患者的年龄和确诊时的阶段，同时复制美国总体癌症发病率和死亡率。该模型包括癌症停留时间，作为癌症进展速度的替代，较短的时间表示快速进展，较长的时间表示较慢的进展。在我们的PDAC模型中，我们的假设是，与没有筛查的组相比，可能通过反事实分析中的假设筛查干预而更早发现癌症将产生更低的死亡率。我们发现，早期发现的好处，如增加寿命年，当逗留时间较短时更大，当在临床诊断前4-6年进行识别时达到最大值(例如，当做出症状诊断时)。然而，当早期检测发生得更早时，例如在临床诊断前6-10年，对于逗留时间较短的癌症来说，好处显著减少，而对于逗留时间较长的癌症来说，好处就会稳定下来。我们的研究阐明了PDAC早期检测的潜在好处，它明确地将个体患者的异质性纳入癌症进展中，并为未来的干预确定了量化基准。
The benefits of cancer early detection depend on various factors, including cancer type, screening method performance, stage at diagnosis, and subsequent treatment. Although numerous studies have evaluated the effectiveness of screening interventions for identifying cancer at earlier stages, there is no quantitative analysis that studies the optimal early detection time interval that results in the greatest mortality benefit; such data could serve as a target and benchmark for cancer early detection strategies. In this study, we focus on pancreatic ductal adenocarcinoma (PDAC), a cancer known for its lack of early symptoms. Consequently, it is most often detected at late stages when the 5-year survival rate is only 3%. We developed a PDAC population model that simulates an individual patient's age and stage at diagnosis, while replicating overall US cancer incidence and mortality rates. The model includes “cancer sojourn time,” serving as a proxy for the speed of cancer progression, with shorter times indicating rapid progression and longer times indicating slower progression. In our PDAC model, our hypothesis was that earlier cancer detection, potentially through a hypothetical screening intervention in the counterfactual analysis, would yield reduced mortality as compared to a no-screening group. We found that the benefits of early detection, such as increased life-years gained, are greater when the sojourn time is shorter, reaching their maximum when identification is made 4–6 years prior to clinical diagnosis (e.g., when a symptomatic diagnosis is made). However, when early detection occurs even earlier, for example 6–10 years prior to clinical diagnosis, the benefits significantly diminish for shorter sojourn time cancers, and level off for longer sojourn time cancers. Our study clarifies the potential benefits of PDAC early detection that explicitly incorporates individual patient heterogeneity in cancer progression and identifies quantitative benchmarks for future interventions.
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影响因子：
5.5
作者：
Iragorri N;Spackman E
通讯作者：
Spackman E
DOI：
10.1186/s13058-022-01505-3
发表时间：
2022-02-23
期刊：
Breast cancer research : BCR
影响因子：
--
作者：
Syriopoulou E;Gasparini A;Humphreys K;Andersson TM
通讯作者：
Andersson TM
影响因子：
2
作者：
Cong, XYJ;Shen, Y;Miller, AB
通讯作者：
Miller, AB
影响因子：
8.8
作者：
Pashayan, N.;Duffy, S. W.;Neal, D. E.
通讯作者：
Neal, D. E.
影响因子：
5.2
作者：
Farr, Katherina P.;Moses, Daniel;Haghighi, Koroush S.;Phillips, Phoebe A.;Hillenbrand, Claudia M.;Chua, Boon H.
通讯作者：
Chua, Boon H.