Screening based on the risk of cancer calculation from Bayesian hierarchical changepoint and mixture models of longitudinal markers
Screening based on the risk of cancer calculation from Bayesian hierarchical changepoint and mixture models of longitudinal markers
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DOI：
10.1198/016214501753168145
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发表时间：
2001-06-01
影响因子：
3.7
通讯作者：
Jacobs, IJ
中科院分区：
文献类型：
--
作者：
Skates, SJ;Pauler, DK;Jacobs, IJ
使用定量标记物及早发现疾病的标准方法是设定一个以人群为基础的固定参考水平，以便做出进一步的个人筛查或转诊决定。对于许多类型的疾病，包括前列腺癌和卵巢癌，额外的信息包含在标记物特定于受试者的时间行为中，这在疾病进程的早期表现出特征性的变化。在这篇文章中，我们推导出一种贝叶斯筛查方法，基于对给定纵向标记水平的疾病后验概率的计算。该方法是由英国的一项随机卵巢癌筛查试验推动的，该试验包括22,000名妇女，在4年内进行了筛查，并平均随访5年。每年在筛查的手臂中记录CA125的抗原水平。来自英国试验的病例和对照的CA125分布使用分层变点和混合模型建模，后验分布使用马尔可夫链蒙特卡罗方法计算，该模型用于计算给定新受试者单一或多个纵向CA125水平时患卵巢癌的贝叶斯后验风险。然后，使用瑞典对5550名妇女进行的独立筛查试验的数据，对基于风险计算的筛查策略进行评估。提出了一种基于卵巢癌风险计算的CA125纵向筛查策略。使用基于纵向CA125值计算的风险的策略进行的前瞻性试验的模拟表明，与基于所有受试者的固定CA125参考水平的标准方法相比，对于给定的特异度，敏感度可能会有很大的提高。
The standard approach to early detection of disease with a quantitative marker is to set a population-based fixed reference level for making further individual screening or referral decisions. For many types of disease, including prostate and ovarian cancer, additional information is contained in the subject-specific temporal behavior of the marker, which exhibits a characteristic alteration early in the course of the disease. In this article we derive a Bayesian approach to screening based on calculation of the posterior probability of disease given longitudinal marker levels. The method is motivated by a randomized ovarian cancer screening trial in the United Kingdom comprising 22,000 women screened over 4 years with an additional 5 years of follow-up on average. Levels of the antigen CA125 were recorded annually in the screened arm. CA125 profiles of cases and controls from the U.K. trial are modeled using hierarchical changepoint and mixture models, posterior distributions are calculated using Markov chain Monte Carlo methods, and the model is used to calculate the Bayesian posterior risk of having ovarian cancer given a new subject's single or multiple longitudinal CA125 levels. A screening strategy based on the risk calculation is then evaluated using data from an independent screening trial of 5,550 women performed in Sweden. A longitudinal CA125 screening strategy based on calculation of the risk of ovarian cancer is proposed. Simulations of a prospective trial using a strategy based on the risk calculated from longitudinal CA125 values indicate potentially large increases in sensitivity for a given specificity compared to the standard approach based on a fixed CA125 reference level for all subjects.