Spillover improved survival in non-invited patients of the colorectal cancer screening programme
Spillover improved survival in non-invited patients of the colorectal cancer screening programme
复制标题
结直肠癌筛查计划的溢出改善了非邀请患者的生存率
DOI：
10.1177/0969141317718220
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发表时间：
2018
影响因子：
2.9
通讯作者：
J. Pitkäniemi
中科院分区：
文献类型：
--
作者：
Joonas Miettinen;N. Malila;M. Hakama;J. Pitkäniemi
在结直肠癌筛查中，随机临床试验显示结直肠癌死亡率平均降低16%，但芬兰随机卫生服务研究显示没有效果。我们量化了溢出效应（该方案对未受邀请者造成的总间接影响），并纠正了芬兰方案的有效性估计。方法我们从芬兰癌症登记处检索了1999-2013年在采用筛查的城市中诊断的所有非受邀结直肠癌患者的数据（n = 18，948）。患者被分层的三个5年的诊断期和两个日历期间的方案通过在居住的市政府。随访于2013年12月31日结束。我们测量了患者生存的溢出效应，基于两对连续诊断期之间结直肠癌相关死亡风险的校正估计值的差异。溢出效应估计为9个百分点（95%置信区间：-1至19个百分点）。男性为13个百分点（-1至26个百分点），女性为5个百分点（-9至20个百分点）。在芬兰实施筛查的校正效果估计为5个百分点。结论：修正后的芬兰疗效估计值与随机试验的估计值一致。间接效应（溢出效应）使邀请者-控制者的对比产生偏差。在这种情况下，溢出效应是芬兰方案的一个固有好处。
Objectives In colorectal cancer screening, randomized clinical trials have shown a 16% mean reduction in colorectal cancer mortality, but the Finnish randomized health services study showed no effect. We quantified spillover (the total indirect effect caused by the programme on the non-invited) and corrected the effectiveness estimate of the Finnish programme. Methods We retrieved from the Finnish Cancer Registry data on all non-invited colorectal cancer patients diagnosed in 1999–2013 in municipalities that adopted screening (n = 18,948). Patients were stratified by three 5-year diagnostic periods and two calendar periods of programme adoption in the municipality of residence. Follow-up ended on 31 December 2013. We measured the spillover effect in patient survival, based on differences of adjusted estimates of the colorectal cancer-related hazard of death between pairs of consecutive diagnostic periods. Results The spillover effect was estimated as 9 percentage points (95% confidence interval: −1 to 19 percentage points). It was 13 percentage points in men (−1 to 26 percentage points) and 5 percentage points in women (−9 to 20 percentage points). The corrected effect estimate of implementing screening in Finland was 5 percentage points. Conclusions The corrected Finnish effectiveness estimate was consistent with estimates from randomized trials. Indirect effects (spillover) bias the invitee–control contrast. In this case, spillover was an inherent benefit of the Finnish programme.
影响因子：
158.5
作者：
MANDEL, JS;BOND, JH;EDERER, F
通讯作者：
EDERER, F