通过降低开始年龄和延长查间隔来提高查结肠镜疗效的潜力:德国的一个建模研究
Dmitry Sergeev1,2, Thomas Heisser1, Michael Hoffmeister1
1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
International journal of cancer
|January 3, 2025
概括
在德国,优化结肠直肠癌查可以显著减少潜在生命损失的年数和因残疾而调整的生命年数. 将开始年龄降至男性45岁,女性50岁,查间隔15年,显示出影响最大的潜力.
科学领域:
- 公共卫生 公共卫生
- 预防医学 预防医学
- 卫生经济学 卫生经济学
背景情况:
- 德国目前的结肠直肠癌 (CRC) 查提供了两次结肠镜检查 (CS),分别为10年,针对50岁以上的男性和55岁以上的女性.
- 评估替代查策略的研究对于优化CRC查至关重要,但在德国缺乏.
研究的目的:
- 通过调整开始年龄和查间隔,探索提高两种CRC查结肠镜 (CS) 的疗效.
- 模拟替代查策略对德国CRC病例,死亡,潜在生命损失年 (YPLL) 和因残疾调整的生命年 (DALYs) 的影响.
主要方法:
- 利用COSIMO,一个经过验证的基于马尔科夫的多态模拟模型.
- 模拟了10万名年龄在45-85岁的男女的假设队伍.
- 模拟了开始年龄 (45-60) 和CS间隔 (10,15,20年) 的各种组合.
主要成果:
- 对于男性来说,15年间隔,第二次CS在65岁时略有减少了CRC死亡. 将开始年龄降至45岁,以15年间隔,显著减少了YPLL和DALYs.
- 对于女性来说,在50岁和65岁时使用两个CS减少了所有CRC负担参数,相比目前的供应 (55岁和65岁).
结论:
- 建议将CRC查结肠镜的起始年龄降至男性45岁,女性50岁.
- 将CS查间隔延长到15年,再加上较早的开始年龄,相比目前的德国查指南,可以显著降低YPLL和DALY.
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