Becker F, Nusko G, Welke J, Hahn E G, Mansmann U
Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Hepatogastroenterology. 2007 Dec;54(80):2249-58.
BACKGROUND/AIMS: For colorectal screening patients a gain of life time was previously calculated to be about 30-50 days. Different recommendations for recognizing at-risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, no benefit-risk analysis regarding specific long-term effects of follow-up patients has been reported to date.
A Markov model based on time-dependent transition possibilities was developed to compare two surveillance schedules: recommendations based on the Erlangen Registry of Colorectal Polyps (ERCRP) and the National Polyp Study (NPS). The outcome was calculated for a 50-year-old patient with 30 years of follow-up after initial polypectomy. The data used in this model were taken from different sources, namely the ERCRP, the German Study Group of Colorectal Cancer, the German Statistical Yearbook, and from meta-analyses of studies reporting data on complications and sensitivity of colonoscopy.
Patients under surveillance have a mean lifetime gain of 98 (ERCRP) and 91 (NPS) days compared with those who do not come for surveillance. Approximately 84% and 79% of deaths from colorectal carcinoma (CRC) could be prevented if patients were followed up according to the recommendations of the ERCRP and the NPS, respectively. The risk of death due to colonoscopy for patients during followup is about 0.05% lifetime risk. Sensitivity analysis showed the stability of the results under a wide range of reasonable variations of relevant parameters. In a pessimistic one-way sensitivity analysis regarding compliance, effectiveness was reduced to one third.
Surveillance using colonoscopy is an effective tool for preventing CRC after colorectal polypectomy and similar to the screening procedure. The effectiveness is slightly higher when following the recommendations of the ERCRP, especially if a more realistic compliance is assumed.
背景/目的：对于接受结直肠癌筛查的患者，此前计算得出的寿命延长约为30 - 50天。关于识别高危人群以及在首次发现结直肠腺瘤后确定监测间隔的不同建议已发表。然而，迄今为止，尚未有关于随访患者特定长期影响的效益风险分析报告。
开发了一种基于时间依赖性转移可能性的马尔可夫模型，以比较两种监测方案：基于埃尔朗根结直肠息肉登记处（ERCRP）和国家息肉研究（NPS）的建议。对一名50岁患者在首次息肉切除术后进行30年随访的结果进行了计算。该模型中使用的数据来自不同来源，即ERCRP、德国结直肠癌研究组、德国统计年鉴以及关于结肠镜检查并发症和敏感性数据报告研究的荟萃分析。
与未接受监测的患者相比，接受监测的患者平均寿命延长98天（ERCRP方案）和91天（NPS方案）。如果按照ERCRP和NPS的建议对患者进行随访，分别可预防约84%和79%的结直肠癌（CRC）死亡。随访期间患者因结肠镜检查导致的死亡风险约为终身风险的0.05%。敏感性分析表明，在相关参数的广泛合理变化范围内，结果具有稳定性。在关于依从性的悲观单向敏感性分析中，有效性降至三分之一。
结肠镜监测是结直肠息肉切除术后预防CRC的有效工具，与筛查程序类似。遵循ERCRP的建议时有效性略高，尤其是在假设更现实的依从性情况下。
