Ethna McFerran, James F O'Mahony, Richard Fallis, Duncan McVicar, Ann G Zauber, Frank Kee
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引用次数: 0
摘要
终生罹患大肠癌的风险为 5%,早期患者的 5 年生存率为 92%。对于在初筛中切除了癌前病变的人,通常建议进行结肠镜监测检查。由于预计患结直肠癌风险较高的人群可获得更大的益处,因此存在针对特定风险提出监测建议的空间。本综述评估了已发表的息肉切除术后监测的成本效益估算,以考虑按风险组别提出个性化建议的可能性。对低风险病例切除息肉术后晚期肿瘤发生率的 Meta 分析结果与无腺瘤的病例相当,两者的发生率均低于 5% 的终生风险。这部分患者可能无法从强化监测中获益,因为强化监测可能会造成不必要的伤害,并使稀缺的结肠镜检查能力得不到有效利用。因此,通过针对低风险人群的非强化策略来提高个性化程度可能是有益的。无创检测(如粪便免疫化学检测)与一级预防或化学预防相结合的潜力可为结肠镜检查在个性化风险分级监控中的有针对性使用预留空间。本综述评估了支持根据风险组别对结直肠腺瘤患者进行个性化监测计划的证据,并比较了结肠镜监测与其他预防策略的有效性。它评估了在决定采用或拒绝个性化监测时必须考虑的成本、效益和不良反应之间的权衡。
Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy.
Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists. This review assesses published cost-effectiveness estimates of postpolypectomy surveillance to consider the potential for personalized recommendations by risk group. Meta-analyses of incidence of advanced neoplasia postpolypectomy for low-risk cases were comparable to those without adenoma, with both rates under the lifetime risk of 5%. This group may not benefit from intensive surveillance, which risks unnecessary harm and inefficient use of often scarce colonoscopy capacity. Therefore, greater personalization through deintensified strategies for low-risk individuals could be beneficial. The potential for noninvasive testing, such as fecal immunochemical tests, combined with primary prevention or chemoprevention may reserve colonoscopy for targeted use in personalized risk-stratified surveillance. This review appraised evidence supporting a program of personalized surveillance in patients with colorectal adenoma according to risk group and compared the effectiveness of surveillance colonoscopy with alternative prevention strategies. It assessed trade-offs among costs, benefits, and adverse effects that must be considered in a decision to adopt or reject personalized surveillance.
期刊介绍:
Epidemiologic Reviews is a leading review journal in public health. Published once a year, issues collect review articles on a particular subject. Recent issues have focused on The Obesity Epidemic, Epidemiologic Research on Health Disparities, and Epidemiologic Approaches to Global Health.