The role and contribution of treatment and imaging modalities in global cervical cancer management: survival estimates from a simulation-based analysis.
The role and contribution of treatment and imaging modalities in global cervical cancer management: survival estimates from a simulation-based analysis.
复制标题
DOI：
10.1016/s1470-2045(20)30316-8
复制
发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Atun R
中科院分区：
文献类型：
--
作者：
Ward ZJ;Grover S;Scott AM;Woo S;Salama DH;Jones EC;El-Diasty T;Pieters BR;Trimble EL;Vargas HA;Hricak H;Atun R
宫颈癌是全球女性中第四大常见癌症，每年有超过30万人死亡。除了筛查和预防外，还需要有效的癌症治疗来降低宫颈癌死亡率。我们探讨了影像学在宫颈癌管理中的作用，并评估了在不同情况下扩大影像学应用对生存的潜在影响。
利用先前开发的全球癌症生存微观模拟模型，我们估算了200个国家/地区特定分期的宫颈癌5年净生存率。我们评估了将治疗（化疗、手术、放疗、靶向治疗）和影像学检查方法（超声、X射线、计算机断层扫描[CT]、磁共振成像[MRI]、正电子发射断层扫描[PET]、单光子发射计算机断层扫描[SPECT]）提升到高收入国家的平均水平对生存的潜在影响，包括单独评估以及综合评估。
据估算，全球宫颈癌5年净生存率为42.1%（95%不确定区间为33.8% - 48.5%）。在各种影像学检查方法中，在全球范围内扩大MRI的应用将带来最大的生存获益，而在低收入国家扩大超声的应用将带来最大的获益，其次是扩大CT的应用，这在拉丁美洲和大洋洲影响最大，在高收入国家PET将带来最大的获益。扩大所有治疗方法的应用可将全球5年净生存率提高到52.4%（95%不确定区间为44.6% - 62.0%）。除了扩大治疗，提高医疗质量可将生存率提高到57.5%（95%不确定区间为51.2% - 63.5%），同时扩大所有影像学检查方法以及扩大治疗和提高医疗质量的累积影响可将生存率提高到62.5%（95%不确定区间为57.7% - 67.8%）。
全面扩大治疗、影像学检查和医疗质量的提升可使全球宫颈癌5年净生存率提高20个百分点，医疗质量和影像学检查的改善各自约占这些潜在总获益的25%。这些研究结果表明，仅仅关注治疗方法的可及性可能会错失大量的生存获益。为了在全球范围内成功扩大宫颈癌治疗，还需要对影像学设备和人员进行投资，并努力提高医疗质量。
Cervical cancer is the fourth most common cancer among women worldwide, with over 300,000 deaths each year. In addition to screening and prevention, effective cancer treatment is needed to reduce cervical cancer mortality. We discuss the role of imaging in cervical cancer management and estimate the potential survival impact of scaling up imaging in different contexts. Using a previously developed microsimulation model of global cancer survival we estimated stage-specific cervical cancer 5-year net survival in 200 countries/territories. We evaluated the potential survival impact of scaling up treatment (chemotherapy, surgery, radiotherapy, targeted therapy) and imaging modalities (ultrasound, X-ray, computerized tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET], single photon emission computed tomography [SPECT]) to the mean level of high-income countries, both individually, and as packages. Estimated global cervical cancer five-year net survival is 42·1% (95% UI 33·8–48·5). Among individual imaging modalities, expanding MRI would yield the largest survival gains globally, while scaling up ultrasound would yield the largest gains in low-income countries, followed by expanding CT, which would have the most impact in Latin America and Oceania, with PET yielding the largest gains in high-income countries. Scaling up all treatment modalities could improve global 5-year net survival to 52·4% (95% UI 44·6–62·0). In addition to expanding treatment, improving quality of care could raise survival to 57·5% (95% UI 51·2–63·5), and the cumulative impact of scaling up all imaging modalities together with expanded treatment and quality of care improves survival to 62·5% (95% UI 57·7–67·8). Comprehensive scale-up of treatment, imaging, and quality of care could improve global cervical cancer 5-year net survival by 20 percentage points, with quality of care and imaging improvements each contributing about 25% of these total potential gains. These findings suggest that a narrow focus on the availability of treatment modalities may forgo substantial survival gains. Investments in imaging equipment and personnel, as well as quality of care efforts will also be needed to successfully scale-up cervical cancer treatment worldwide.