在有症状的患者中检测多种癌症的临床实用性:决策的视角
Giuliano Netto Flores Cruz1,2,3, Keegan Korthauer1,2
1Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital Research Institute, Vancouver, Canada.
JCO precision oncology
|December 5, 2025
概括
多种癌症检测 (MCD) 血液测试对症状患者,特别是妇科和胃肠道癌症的临床实用性表明. 需要针对特定路径进行优化,但不需要重新训练分类器.
科学领域:
- 在瘤学瘤学.
- 诊断医学 诊断医学 诊断医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 对症状患者多种癌症检测 (MCD) 血液检测越来越感兴趣.
- 人们对MCD测试的敏感性存在担忧,即在没有分类器再培训的情况下,在有症状的个体中排除癌症.
研究的目的:
- 通过使用诊断决策框架,正式评估MCD测试在症状患者中的临床实用性.
- 为了评估MCD测试的表现与怀疑癌症转诊的临床指南相比.
主要方法:
- 利用了SYMPLIFY研究的数据来评估Galleri MCD测试.
- 从国家卫生和护理卓越研究所指南12中提取了决策门.
- 通过贝叶斯决策曲线分析估计的临床效用.
主要成果:
- 盖勒里MCD测试显示,临床效用概率为99.4%,在3%的门下,每10万名患者中避免了18005次不必要的转诊.
- 对于妇科,下部肠道和上部肠道通道发现了很高的实用性,避免了2541462501个不必要的转介.
- 对于快速诊断中心和肺部通路,观察到可忽略的效用,通路的灵敏度要求各不相同.
结论:
- 在英国有症状的患者中进行MCD测试的临床实用性取决于途径,对妇科和胃肠道癌症显示出有利性.
- 针对MCD测试的特定路径优化应优先考虑临床效用.
- 对于未来的MCD测试优化,不需要重新训练机器学习分类器.
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