Chiu Sherry Yueh-Hsia, Malila Nea, Yen Amy Ming-Fang, Chen Sam Li-Sheng, Fann Jean Ching-Yuan, Hakama Matti
1 Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
2 Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
J Med Screen. 2017 Dec;24(4):182-188. doi: 10.1177/0969141316684524. Epub 2017 Jan 13.
Objective Because colorectal cancer (CRC) has a long natural history, estimating the effectiveness of CRC screening programmes requires long-term follow-up. As an alternative, we here demonstrate the use of a temporal multi-state natural history model to predict the effectiveness of CRC screening. Methods In the Finnish population-based biennial CRC screening programme using faecal occult blood tests (FOBT), which was conducted in a randomised health services study, we estimated the pre-clinical incidence, the mean sojourn time (MST), and the sensitivity of FOBT using a Markov model to analyse data from 2004 to 2007. These estimates were applied to predict, through simulation, the effects of five rounds of screening on the relative rate of reducing advanced CRC with 6 years of follow-up, and on the reduction in mortality with 10 years of follow-up, in a cohort of 500,000 subjects aged 60 to 69. Results For localised and non-localised CRC, respectively, the MST was 2.06 and 1.36 years and the sensitivity estimates were 65.12% and 73.70%. The predicted relative risk of non-localised CRC and death from CRC in the screened compared with the control population was 0.86 (95% CI: 0.79-0.98) and 0.91 (95% CI: 0.85-1.02), respectively. Conclusion Based on the preliminary results of the Finnish CRC screening programme, our model predicted a 9% reduction in CRC mortality and a 14% reduction in advanced CRC.
目的 由于结直肠癌（CRC）具有较长的自然病史，评估CRC筛查项目的有效性需要长期随访。作为一种替代方法，我们在此展示使用时间多状态自然病史模型来预测CRC筛查的有效性。方法 在芬兰基于人群的每两年进行一次的粪便潜血试验（FOBT）CRC筛查项目中，该项目在一项随机卫生服务研究中开展，我们使用马尔可夫模型分析2004年至2007年的数据，估计临床前发病率、平均停留时间（MST）以及FOBT的敏感性。将这些估计值应用于通过模拟预测在一个50万60至69岁的队列中，五轮筛查对6年随访期内晚期CRC相对降低率以及10年随访期内死亡率降低的影响。结果 对于局限性和非局限性CRC，MST分别为2.06年和1.36年，敏感性估计值分别为65.12%和73.70%。与对照人群相比，筛查人群中预测的非局限性CRC和CRC死亡的相对风险分别为0.86（95%CI：0.79 - 0.98）和0.91（95%CI：0.85 - 1.02）。结论 根据芬兰CRC筛查项目的初步结果，我们的模型预测CRC死亡率降低9%，晚期CRC降低14%。
