用于结直肠癌筛查的新血液检测的比较益处、负担和危害

Reinier G S Meester, Andrew J Piscitello, Joseph A Duimstra, Peter S Liang, Aasma Shaukat, Theodore R Levin
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引用次数: 0

摘要

新出现的血液检查可能提高结直肠癌(CRC)筛查的吸收和结果,但对晚期癌前病变的敏感性低于目前推荐的一些检查。我们检查这些测试是否符合美国预防服务工作组(USPSTF)建议的期望。方法复制了一个告知USPSTF的决策分析模型,并用于评估45-75岁之间每年、两年或三年血液检查的终身获益(避免CRC病例和死亡,获得的生命年[LYG])、负担(所需的筛查检查和结肠镜检查)和危害(结肠镜检查相关并发症),与推荐的基准和当代基于粪便的策略相比,结肠镜检查作为参考。基本案例分析假设100%的依从性。敏感性分析评估了更现实的情景。在基准策略中,结肠镜筛查的益处最大,估计避免了30例结直肠癌死亡,356例LYG,每1000名成年人需要4270例结肠镜检查和15例并发症;以粪便为基础的策略导致81-88%的LYG用于结肠镜检查,6829 - 19476次筛查试验,1523-1880次结肠镜检查,9-10次并发症。相比之下,结肠镜检查的年度血液检查导致85-87%的LYG,筛查、结肠镜检查和并发症的比例中等。两年一次和三年一次的血液检测为结肠镜检查提供了57-72%的LYG,但在合理的情况下,与现有策略相比,增加使用可产生净人口效益。结论:每年血液检查的获益、负担和危害均在当前CRC筛查策略的范围内。鉴于提高利用和人口净惠益的潜力,还应考虑每两年和每三年进行一次试验以提出建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative benefits, burdens and harms of emerging blood-based tests for colorectal cancer screening
Background Emerging blood tests may improve colorectal cancer (CRC) screening uptake and outcomes but are less sensitive for advanced precancerous lesions than some currently recommended tests. We examine whether these tests meet expectations for U.S. Preventive Services Task Force (USPSTF) recommendation. Methods A decision-analytic model that informed USPSTF was replicated and used to estimate the lifetime benefits (averted CRC cases & deaths, life-years gained [LYG]), burdens (required screening tests & colonoscopies), and harms (colonoscopy-related complications) for annual, biennial or triennial blood testing through age 45-75 years vs a benchmark of recommended and contemporary stool-based strategies, with colonoscopy screening as the reference. Base-case analyses assumed 100% adherence. Sensitivity analyses evaluated more realistic scenarios. Results Among benchmark strategies, colonoscopy screening had the most benefit, with an estimated 30 CRC deaths averted, 356 LYG, 4270 colonoscopies required and 15 complications per 1000 adults; stool-based strategies resulted in 81–88% of LYG for colonoscopy, 6829–19,476 screening tests, 1523–1880 colonoscopies, and 9–10 complications. By comparison, annual blood testing resulted in 85–87% of LYG for colonoscopy and an intermediate number of screenings, colonoscopies and complications. Biennial and triennial blood testing provided 57–72% of LYG for colonoscopy but resulted in net population benefit under plausible scenarios for increased utilization vs existing strategies. Conclusions The estimated benefits, burdens and harms of annual blood testing are within the range of current CRC screening strategies. Biennial and triennial testing should also be considered for recommendation given potential for increased utilization and net population benefit.
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