将结肠镜与便免疫化学测试相结合,可以改善目前的家族结肠直肠癌结肠镜监测:一项建模研究
Francine van Wifferen1, Marjolein J E Greuter1, Monique E van Leerdam2
1Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands.
Gastroenterology
|August 30, 2024
概括
优化结肠直肠癌 (CRC) 监测对具有家族史的个人结肠直肠癌 (FCRC) 可以通过10年一次结肠镜和两年一次便免疫化学测试 (FIT) 的战略实现. 这种方法提高了质量调整寿命年 (QALYs),同时降低了结肠镜检查的频率和成本.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 预防医学 预防医学
背景情况:
- 家庭结肠直肠癌 (FCRC) 监测旨在优化因家族病史而增加CRC风险的个体的护理.
- 当前的监控策略可能不是管理FCRC风险的最有效或最具成本效益的方法.
研究的目的:
- 评估和优化家族性结肠直肠癌 (FCRC) 监测策略在没有遗传性CRC的个体.
- 确定最有效和最具成本效益的监管方法,平衡利益和负担.
主要方法:
- 用Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA) -FCRC模型来模拟2倍和4倍增加CRC风险的个体的CRC发展.
- 模拟策略包括没有监测,目前的荷兰指导方针 (每5年一次结肠镜检查),以及不同间隔和年龄段的结肠镜检查和便免疫化学测试 (FIT) 的各种组合.
- 最佳策略是通过最大限度地提高质量调整寿命年 (QALYs),同时满足成本效益,效率不低于,与当前监测相比可以管理的结肠镜检查负担的标准来定义.
主要成果:
- 最优的策略包括每10年进行一次结肠镜检查,每2年进行一次FIT检查,年龄在40至80岁之间,对于两倍至四倍增加的CRC风险.
- 对于两倍的风险,这种策略可以预防更多的CRC死亡,获得QALY,减少731次结肠镜检查,与目前的监测相比,每1000人节省98,000欧元.
- 对于4倍的风险,它预防了更多的CRC死亡,获得了QALY,减少了567次结肠镜检查,并为每1000个人节省了127,000欧元,证明了比当前方法更高的效率.
结论:
- 便免疫化学测试 (FIT) 可以显著提高FCRC监测的有效性和效率.
- 与每两年一次的FIT相结合的10年一次结肠镜的拟议策略增加了QALY,减少了结肠镜负担,并降低了与当前FCRC监测协议相比的成本.
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