结肠直肠癌查:美国预防服务工作组的最新建模研究
Amy B Knudsen1,2, Carolyn M Rutter3, Elisabeth F P Peterse4,5
1Institute for Technology Assessment, Massachusetts General Hospital, Boston.
在45岁开始进行结直肠癌查, 这种方法最大限度地增加了寿命 (LYG),同时优化了对平均风险个体的结肠镜检查.
科学领域:
- 预防医学
- 胃肠病学
- 医疗服务研究
背景情况:
- 美国预防服务工作组 (USPSTF) 正在修订其2016年结肠直肠癌 (CRC) 查指南.
- 需要更新证据来评估各种CRC查策略的好处,负担和危害.
研究的目的:
- 提供基于模型的CRC查策略的最新估计.
- 确定有效平衡增长寿命年数 (LYG) 与结肠镜检查负担的策略.
主要方法:
- 使用三种微模拟模型进行比较建模研究.
- 用各种测试 (FIT,便DNA,西格莫视镜,CT结肠镜,结肠镜) 对40岁美国平均风险人群进行查.
- 评估LYG,终身结肠镜检查和并发症;定义效率为每次额外的LYG更少的结肠镜检查.
主要成果:
- 估计LYG在每1000人中为171至381;终身结肠镜在624至6817人之间.
- 在所有模型中,在49个有效策略中,在45岁开始查是其中41个策略的一部分.
- 将查开始年龄从50岁降至45岁,估计每1000人增加了22-27个LYG.
结论:
- 从45岁开始进行结肠直肠癌查,使用便检查,内镜检查或CT结肠镜检查,
- 这种方法优化了结肠镜检查负担与增加寿命之间的权衡,为更新的查建议提供了信息.
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