Short-term Endpoints for Cancer Screening Trials: Does Tumor Subtype Matter?
Short-term Endpoints for Cancer Screening Trials: Does Tumor Subtype Matter?
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癌症筛查试验的短期终点：肿瘤亚型重要吗？
DOI：
10.1158/1055-9965.epi-22-1307
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发表时间：
2023-06-01
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多种癌症早期检测测试正在促使人们重新审视癌症筛查试验的潜在短期终点。晚期发病率的降低是主要候选者，并且用早期生存代替晚期生存的分期模型已被用来预测筛查引起的死亡率降低。然而，标准的阶段转移模型经常忽略预后亚型，这实际上意味着早期发现的癌症也有相关的亚型转移。为了说明忽略与保留预后亚型的分期模型的死亡率预测之间的差异，我们使用按组织学亚型划分的卵巢癌和按级别划分的前列腺癌。我们推断出一般条件，在这种条件下，保留预后亚型的阶段转移模型可能会预测与忽略亚型的模型不同的死亡率降低，并根据癌症筛查试验的阶段检查对短期终点的影响。
Multi-cancer early detection tests are precipitating a re-examination of potential short-term endpoints for cancer screening trials. A reduction in advanced stage incidence is a prime candidate, and stage-shift models that substitute early-stage for late-stage survival have been used to predict mortality reduction due to screening. However, standard stage-shift models often ignore prognostic subtypes, effectively implying that cancers detected early also have an associated subtype shift. To illustrate the differences between mortality predictions from stage-shift models that ignore versus preserve prognostic subtype, we use ovarian cancer partitioned by histologic subtype and prostate cancer partitioned by grade. We infer general conditions under which stage-shift models that preserve prognostic subtype are likely to predict mortality reductions that differ from those that ignore subtype and examine the implications for short-term endpoints based on stage in cancer screening trials.