Surveillance Strategies Following Treatment for CIN

CIN 治疗后的监测策略

• 批准号: 6927716
• 负责人: JOY MELNIKOW
• 金额: $ 29.67万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-01 至 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6927716
• 关键词: Surveillance; Strategies; Following; Treatment; CIN

DESCRIPTION (provided by applicant): Though now less common in developed countries than previously, in 2003 cervical cancer is projected to result in 12,200 new cases and 4,100 deaths in the United States. These relatively low rates are attributed to the success of cervical cancer screening and treatment of cervical intraepithelial neoplasia (CIN). To reduce further the incidence and mortality of cervical cancer in developed countries while avoiding unnecessary procedures and conserving resources is a challenge that confronts clinicians and health policy makers. The recent move away from recommending lifelong annual cervical cancer screening towards consistent screening every two to three years is one example of an effort to meet this challenge. Recent estimates for the US indicate that more than one million women are diagnosed with low-grade neoplasia (CIN I) annually, and that about 500,000 women will have higher-grade lesions (CIN 2 or CIN 3). Follow-up strategies must strike a balance between finding and treating persistent or recurrent lesions and potential overuse of procedures and resources. The recent publication of the findings from the ALTS trial has led to recommendations for the management and follow-up of CIN. These recommendations include follow-up after treatment at 4 to 6 month intervals until three negative cytology results are obtained, followed by annual screening. The duration of annual screening remains unspecified, however, and the long-term risk and time patterns of recurrence of CIN or invasive cancer after treatment remain unclear. The relative costeffectiveness of these recommendations has not been evaluated. Given the large number of women diagnosed with CIN every year, over time a substantial number of women will be assigned to long-term annual cytology for post-treatment surveillance. Our study will examine the long-term risks of recurrent CIN and changes in risk over time in a cohort drawn from a comprehensive, population-based dataset. Based on this data and previous work, we will conduct a cost-effectiveness analysis to compare strategies for longterm follow-up of women who have undergone evaluation and treatment of CIN. Data from the cohort study and a systematic review of the literature will be used for recurrence risks, costs will be estimated by coding of clinical pathways, and utilities obtained from diverse populations will be applied to a previously validated Markov model. Alternative strategies for post-treatment surveillance will be evaluated.

描述（由申请人提供）：尽管目前宫颈癌在发达国家的发病率比以前有所下降，但预计 2003 年宫颈癌将在美国造成 12,200 例新病例和 4,100 例死亡。这些相对较低的比率归因于宫颈癌筛查和宫颈上皮内瘤变（CIN）治疗的成功。在发达国家，进一步降低宫颈癌的发病率和死亡率，同时避免不必要的手术并节省资源，是临床医生和卫生政策制定者面临的挑战。最近从建议终身每年进行一次宫颈癌筛查转向每两到三年进行一次持续筛查，就是应对这一挑战的一个例子。最近对美国的估计表明，每年有超过 100 万女性被诊断患有低度肿瘤 (CIN I)，并且大约 500,000 名女性将患有高级病变（CIN 2 或 CIN 3）。后续策略必须在发现和治疗持续性或复发性病变与潜在的程序和资源过度使用之间取得平衡。最近公布的 ALTS 试验结果为 CIN 的管理和随访提出了建议。这些建议包括治疗后每隔 4 至 6 个月进行一次随访，直至获得三个阴性细胞学结果，然后每年进行筛查。然而，年度筛查的持续时间仍未明确，治疗后 CIN 或浸润性癌症复发的长期风险和时间模式仍不清楚。这些建议的相对成本效益尚未得到评估。鉴于每年有大量女性被诊断患有 CIN，随着时间的推移，大量女性将被分配进行长期年度细胞学检查以进行治疗后监测。我们的研究将检查复发性 CIN 的长期风险以及从基于人群的综合数据集中抽取的队列中风险随时间的变化。根据这些数据和之前的工作，我们将进行成本效益分析，以比较对接受过 CIN 评估和治疗的女性进行长期随访的策略。来自队列研究的数据和对文献的系统回顾将用于复发风险，成本将通过临床路径编码进行估计，从不同人群获得的效用将应用于先前验证的马尔可夫模型。将评估治疗后监测的替代策略。