Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force.
Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force.
复制标题
DOI：
10.1001/jama.2016.6828
复制
发表时间：
2016-06-21
期刊：
影响因子：
--
通讯作者：
Kuntz KM
中科院分区：
文献类型：
--
作者：
Knudsen AB;Zauber AG;Rutter CM;Naber SK;Doria-Rose VP;Pabiniak C;Johanson C;Fischer SE;Lansdorp-Vogelaar I;Kuntz KM
美国预防服务工作组（USPSTF）正在更新其2008年结直肠癌（CRC）筛查建议。通过建模CRC筛查策略的益处、负担和危害，为USPSTF提供信息；估计开始和结束筛查的最佳年龄；并确定一套模型推荐策略，提供相似的获得生命年（LYG），并在LYG和筛查负担之间取得可比的平衡。比较建模与3个微观模拟模型的假设队列先前未筛选的美国40岁无CRC诊断。在45岁、50岁或55岁开始筛查，在75岁、80岁或85岁结束筛查，采用敏感的愈疮胶粪便隐血试验、粪便免疫化学试验（FIT）、多靶点粪便DNA试验、带或不带粪便试验的柔性乙状结肠镜检查、计算机断层结肠镜检查（CTC）或结肠镜检查。筛查间隔因治疗方式而异。假设所有策略都完全遵守。与不进行筛查相比获得的生命年数（获益）、一生中需要结肠镜检查的次数（负担）、一生中结肠镜检查并发症的次数（危害）以及每1000名40岁人群的增量负担和获益比（效率比）。筛查策略为每1000名40岁的人提供了152至313例LYG。每1000人的终生结肠镜检查负担从不足900人（55-75岁期间每3年检查一次）到超过7500人（45-85岁期间每5年进行结肠镜检查一次）不等。筛查的危害是每1000名接受筛查的人中最多有23例并发症。与55岁开始筛查的策略相比，从50岁开始筛查的策略通常提供更多的LYG以及每额外一次结肠镜检查提供更多的LYG。有限的经验数据支持起始年龄为45岁。对于75岁以下充分筛查的人，额外筛查导致LYG相对于结肠镜检查负担的增加有小幅增加。在50至75岁的筛查人群中，有4种策略产生了相当的筛查负担平衡和相似的LYG（模型中每1000人的中位数LYG）：每10年结肠镜检查（270 LYG）；每10年一次乙状结肠镜检查，每年一次FIT (256 LYG)；CTC每5年（248 LYG）；年度FIT （244lyg）。在这项微观模拟模型研究中，对先前未接受CRC筛查的人群进行了假设100%依从性的筛查，从50岁到75岁，每10年进行一次结肠镜检查，每年进行一次FIT，每10年进行一次乙状结肠镜检查，每年进行一次FIT，每5年进行一次CTC，这些策略提供了相似的LYG和可比较的获益和筛查负担平衡。
The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations. To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating the optimal ages to begin and end screening; and identifying a set of model-recommendable strategies that provide similar life-years gained (LYG) and a comparable balance between LYG and screening burden. Comparative modeling with 3 microsimulation models of a hypothetical cohort of previously unscreened US 40-year-olds with no prior CRC diagnosis. Screening with sensitive guaiac-based fecal occult blood testing, fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy with or without stool testing, computed tomographic colonography (CTC), or colonoscopy starting at age 45, 50, or 55 years and ending at age 75, 80, or 85 years. Screening intervals varied by modality. Full adherence for all strategies was assumed. Life-years gained compared with no screening (benefit), lifetime number of colonoscopies required (burden), lifetime number of colonoscopy complications (harms), and ratios of incremental burden and benefit (efficiency ratios) per 1000 40-year-olds. The screening strategies provided LYG in the range of 152 to 313 per 1000 40-year-olds. Lifetime colonoscopy burden per 1000 persons ranged from fewer than 900 (FIT every 3 years from ages 55–75 years) to more than 7500 (colonoscopy screening every 5 years from ages 45–85 years). Harm from screening was at most 23 complications per 1000 persons screened. Strategies with screening beginning at age 50 years generally provided more LYG as well as more additional LYG per additional colonoscopy than strategies with screening beginning at age 55 years. There were limited empirical data to support a start age of 45 years. For persons adequately screened up to age 75 years, additional screening yielded small increases in LYG relative to the increase in colonoscopy burden. With screening from ages 50 to 75 years, 4 strategies yielded a comparable balance of screening burden and similar LYG (median LYG per 1000 across the models): colonoscopy every 10 years (270 LYG); sigmoidoscopy every 10 years with annual FIT (256 LYG); CTC every 5 years (248 LYG); and annual FIT (244 LYG). In this microsimulation modeling study of a previously unscreened population undergoing CRC screening that assumed 100% adherence, the strategies of colonoscopy every 10 years, annual FIT, sigmoidoscopy every 10 years with annual FIT, and CTC every 5 years performed from ages 50 through 75 years provided similar LYG and a comparable balance of benefit and screening burden.