Surveillance Strategies Following Treatment for CIN

描述（由申请人提供）：虽然现在在发达国家不像以前那么常见，但在2003年，预计宫颈癌在美国将导致12,200例新病例和4,100例死亡。这些相对较低的发病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和节约资源，是临床医生和卫生决策者面临的一项挑战。最近从建议终身每年进行宫颈癌筛查改为每两到三年进行一次持续筛查的做法，就是努力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100万妇女被诊断为低级别肿瘤（CIN I），约50万妇女将有更高级别的病变（CIN 2或CIN 3）。随访策略必须在发现和治疗持续性或复发性病变和潜在的过度使用程序和资源之间取得平衡。最近发表的ALTS试验结果对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个月随访一次，直到获得3个阴性细胞学结果，然后每年进行筛查。然而，每年筛查的时间仍未确定，治疗后CIN或侵袭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价。鉴于每年有大量女性被诊断为CIN，随着时间的推移，相当多的女性将被分配到长期的年度细胞学检查，以进行治疗后的监测。我们的研究将检查复发性CIN的长期风险和风险随时间的变化，这些风险来自一个全面的、基于人群的数据集。基于这些数据和之前的工作，我们将进行成本-效果分析，比较接受CIN评估和治疗的女性的长期随访策略。来自队列研究的数据和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来估计，从不同人群中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备选策略。

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.