A proposed new generation of evidence-based microsimulation models to inform global control of cervical cancer.
A proposed new generation of evidence-based microsimulation models to inform global control of cervical cancer.
复制标题
新一代基于证据的微观模拟模型为宫颈癌的全球控制提供信息。
DOI：
10.1016/j.ypmed.2021.106438
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发表时间：
2021-03
影响因子：
5.1
通讯作者：
Schiffman M
中科院分区：
文献类型：
--
作者：
Campos NG;Demarco M;Bruni L;Desai KT;Gage JC;Adebamowo SN;de Sanjose S;Kim JJ;Schiffman M
健康决策模型是唯一可用的工具，旨在考虑人类乳头瘤病毒(HPV)感染的终身自然历史和宫颈癌的发病机制，以及预防干预措施的估计长期影响。然而，健康决策建模结果通常被认为是较少形式的科学证据，因为内在需要依赖不完美的数据，并对复杂的过程做出许多假设和推断。我们提出了一个新的健康决策建模框架，由于细胞学-镜-组织学诊断的主观性和缺乏重复性，该框架不强调细胞学-镜-组织学诊断，而是依赖于HPV类型和感染持续时间作为后续转移概率的主要决定因素。我们假设新的模型健康状态(正常、致癌的HPV感染、癌前病变、癌症)和必然的转变是普遍的，但状态之间的转变的概率可能因人群而异。宿主对HPV感染反应的这种差异性的证据可以从不同地区不同地区的HPV感染流行模式中推断出来，这可能与不同人群对HPV感染的免疫控制水平有关。通过优先从纵向数据直接估计模型转移概率(并限制对模型拟合技术的依赖，这些技术在应用于多个转移时可能传播错误)，我们的目标是减少假设的数量，以获得更大的透明度和可靠性。我们提出了这一新的微观模拟模型，以供评论和讨论，希望对最大限度地为全球消除宫颈癌的有效战略提供参考的模型做出贡献。
Health decision models are the only available tools designed to consider the lifetime natural history of human papillomavirus (HPV) infection and pathogenesis of cervical cancer, and the estimated long-term impact of preventive interventions. Yet health decision modeling results are often considered a lesser form of scientific evidence due to the inherent needs to rely on imperfect data and make numerous assumptions and extrapolations regarding complex processes. We propose a new health decision modeling framework that de-emphasizes cytologic-colposcopic-histologic diagnoses due to their subjectivity and lack of reproducibility, relying instead on HPV type and duration of infection as the major determinants of subsequent transition probabilities. We posit that the new model health states (normal, carcinogenic HPV infection, precancer, cancer) and corollary transitions are universal, but that the probabilities of transitioning between states may vary by population. Evidence for this variability in host response to HPV infections can be inferred from HPV prevalence patterns in different regions across the lifespan, and might be linked to different average population levels of immunologic control of HPV infections. By prioritizing direct estimation of model transition probabilities from longitudinal data (and limiting reliance on model-fitting techniques that may propagate error when applied to multiple transitions), we aim to reduce the number of assumptions for greater transparency and reliability. We propose this new microsimulation model for critique and discussion, hoping to contribute to models that maximally inform efficient strategies toward global cervical cancer elimination.
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DOI：
10.1016/j.bpobgyn.2017.08.001
发表时间：
2018-02-01
影响因子：
5.5
作者：
Doorbar, John
通讯作者：
Doorbar, John
影响因子：
9.8
作者：
Cox, JT;Schiffman, M;Solomon, D
通讯作者：
Solomon, D
影响因子：
5
作者：
Campos, Nicole G.;Burger, Emily A.;Kim, Jane J.
通讯作者：
Kim, Jane J.
影响因子：
39.2
作者：
Goldie, SJ;Weinstein, MC;Freedberg, KA
通讯作者：
Freedberg, KA
影响因子：
5.5
作者：
Gonzalez, Paula;Hildesheim, Allan;Kreimer, Aimee R.
通讯作者：
Kreimer, Aimee R.