EVALUATING THE SURVIVAL OF CANCER CASES DETECTED BY SCREENING
EVALUATING THE SURVIVAL OF CANCER CASES DETECTED BY SCREENING
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DOI：
10.1002/sim.4780060804
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发表时间：
1987-12-01
影响因子：
2
通讯作者：
STITT, LW
中科院分区：
文献类型：
--
作者：
WALTER, SD;STITT, LW
通过筛查早期发现癌症可以提前诊断日期，但可能会或可能不会影响生存。为了评估与早期检测相关的生存获益，必须估计导入期后生存时间的分布，即在未进行筛选的情况下发生临床诊断的未知日期之后。然后，可以将筛查检测到的癌症病例的调整后生存期与未通过筛查诊断的其他病例组进行比较。本文描述了一个模型的屏幕检测的情况下，生存的风险函数，取决于个人的前置时间，临床前疾病的持续时间，以及自诊断的时间。该模型适用于著名的HIP（大纽约健康保险计划）研究中132例筛查检测的乳腺癌病例的10年生存数据。比较几组未被筛查发现的癌症病例的生存率（既往筛查患者中临床出现的间隔病例，拒绝筛查患者中的病例，以及未接受筛查的随机对照病例），得出了不同的获益估计。使用间隔病例进行比较，估计在HIP研究中筛查的20，166名妇女中预防了约21例乳腺癌死亡;使用随机对照数据估计预防了约25例死亡。前一个估计数仅来自接受筛查的妇女群体，因此同样的评估方法也可适用于社区筛查方案和其他不需要随机化的情况。
Early detection of cancer by screening advances the date of diagnosis, but may or may not affect survival. To assess the survival benefit associated with early detection, one must estimate the distribution of time survived post lead-time, that is, after the unknown date when clinical diagnosis would have occurred in the absence of screening. One can then compare the adjusted survival of screen-detected cancer cases to other groups of cases not diagnosed by screening. This paper describes a model for the survival of screen-detected cases, with a hazard function that depends on an individual''s lead time, the duration of preclinical disease, and the time since diagnosis. The model is fitted to the ten year survival data from the 132 screen-detected cases of breast cancer in the well-known HIP (Health Insurance Plan of Greater New York) study. Comparison with the survival of several groups of cancer cases not detected by screening (interval cases arising clinically in persons previously screened, cases among persons who refuse screening, and cases among randomized controls not offered screening yields various estimates of benefit. Use of the interval cases for comparison gives an estimate of about 21 breast cancer deaths prevented among 20,166 women screened in the HIP study; use of the data from the randomized controls gives an estimate of about 25 prevented deaths. The former estimate derives from the screened group of women only, and so the same method of evaluation may also be applied to community screening programmes and other situations that do not entail randomization.