Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin (Department of Management Sciences, University of Waterloo Waterloo (FSE, OA)
Formerly at Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Current affiliation is Analysis Group, Inc., Boston, Massachusetts (RB)
Med Decis Making. 2011 Jul-Aug;31(4):611-24. doi: 10.1177/0272989X10391809. Epub 2011 Jan 6.
Some aspects of the natural history of metachronous colorectal cancer (MCRC), such as the rate of progression from adenomatous polyp to MCRC, are unknown. The objective of this study is to estimate a set of parameters revealing some of these unknown characteristics of MCRC.
The authors developed a computer simulation model that mimics the progression of MCRC for a 5-year period following the treatment of primary colorectal cancer (CRC). They obtained the inputs of the simulation model using longitudinal data for 284 CRC patients from the Mayo Clinic, Rochester.
Five-year MCRC incidence and all-cause mortality were 7.4% and 12.7% in the patient cohort, respectively. Statistical analysis showed that 5-year MCRC incidence was associated with gender (P = 0.05), whereas both all-cause and CRC-related mortalities were associated with age (P < 0.001 and P = 0.01). Estimated annual probabilities of progression from adenomatous polyp to MCRC and from MCRC to metastatic MCRC were 0.14 and 0.28, respectively. Annual probabilities of mortality after MCRC and metastatic MCRC treatments were estimated to be 0.06 and 0.26, respectively. The estimated annual probability of mortality due to undetected MCRC was 0.16.
The results imply that MCRC, especially in women, may be more common than suggested by previous studies. In addition, statistics derived from the clinical data and results of the simulation model indicate that gender and age affect the progression of MCRC.
一些结直肠多发癌（MCRC）的自然史特征尚不明确，如腺瘤性息肉进展为 MCRC 的速度。本研究旨在估计一组参数，以揭示 MCRC 的一些未知特征。
作者开发了一个计算机模拟模型，模拟了原发性结直肠癌（CRC）治疗后 5 年内 MCRC 的进展情况。他们使用来自梅奥诊所罗切斯特院区的 284 例 CRC 患者的纵向数据为模拟模型输入。
患者队列的 5 年 MCRC 发病率和全因死亡率分别为 7.4%和 12.7%。统计分析显示，5 年 MCRC 发病率与性别有关（P=0.05），而全因死亡率和 CRC 相关死亡率均与年龄有关（P<0.001 和 P=0.01）。估计的从腺瘤性息肉进展为 MCRC 和从 MCRC 进展为转移性 MCRC 的 5 年进展概率分别为 0.14 和 0.28。MCRC 和转移性 MCRC 治疗后死亡的年概率估计分别为 0.06 和 0.26。未检测到的 MCRC 导致的年死亡率估计为 0.16。
结果表明，MCRC，特别是女性中的 MCRC，可能比之前的研究更为常见。此外，从临床数据和模拟模型的结果得出的统计学数据表明，性别和年龄影响 MCRC 的进展。
