个性化活检时间表使用间隔审查的因果特定关节模型.
Zhenwei Yang1,2, Dimitris Rizopoulos1,2, Eveline A M Heijnsdijk3
1Department of Biostatistics, Erasmus Medical Center Rotterdam, South Holland, the Netherlands.
Statistics in medicine
|May 26, 2025
概括
为积极监测 (AS) 提供个性化活检计划,可将前列腺癌活检量减少高达52%. 这种方法使用间隔审查的特定原因联合模型 (ICJM) 来根据个体风险量身定制测试频率,最大限度地减少过度治疗.
科学领域:
- 在瘤学瘤学.
- 生物统计学 生物统计学
- 医疗信息学 医疗信息学
背景情况:
- 前列腺癌的积极监测 (AS) 减少了过度治疗,但依赖于固定的活检时间表.
- 目前的固定的活检时间表没有个性化,并且可能导致患者因频繁的侵入性手术而承担负担.
- 在AS中监测癌症进展的最佳频率仍未确定.
研究的目的:
- 为前列腺癌积极监测制定个性化活检调度策略.
- 模拟纵向生物标志物对癌症进展的影响,同时考虑竞争性风险.
- 通过平衡手术数量和检测延迟来优化活检时间.
主要方法:
- 提出了一个间隔审查的因果特定联合模型 (ICJM),以整合纵向生物标志物和癌症进展.
- 嵌入式间隔审查,早期治疗的竞争风险,以及进展检测的不确定性.
- 开发了针对患者的特定风险概况,以便在超出预定义的风险值时触发活检.
主要成果:
- ICJM成功地用竞争风险和间隔审查来建模癌症的进展.
- 与固定时间表相比,个性化活检计划显著减少了每个患者的活检数量,减少了41%-52%.
- 活检的减少伴随着癌症进展检测延迟的轻微增加.
结论:
- 基于患者特异性风险概况的个性化活检计划对于前列腺癌AS是可行的和有效的.
- 拟议的ICJM为优化AS监测提供了一个强大的统计框架.
- 这种方法有可能减少与前列腺癌管理相关的患者负担和医疗保健成本.
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