McFerran Ethna, O'Mahony James F, Fallis Richard, McVicar Duncan, Zauber Ann G, Kee Frank
Epidemiol Rev. 2017 Jan 1;39(1):148-160. doi: 10.1093/epirev/mxx002.
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.
患结直肠癌的终生风险为5%，早期的5年生存率为92%。在初次筛查时切除癌前病变的个体通常建议进行监测性结肠镜检查。由于预计结直肠癌风险较高的个体受益更大，因此存在针对特定风险的监测建议空间。本综述评估了已发表的息肉切除术后监测的成本效益估计，以考虑按风险组进行个性化建议的可能性。对低风险病例息肉切除术后高级别瘤变发生率的荟萃分析与无腺瘤者相当，两者发生率均低于5%的终生风险。该组可能无法从强化监测中获益，强化监测有造成不必要伤害和低效利用通常稀缺的结肠镜检查能力的风险。因此，通过对低风险个体采用弱化策略实现更大程度的个性化可能有益。粪便免疫化学检测等非侵入性检测与一级预防或化学预防相结合的可能性，可能会将结肠镜检查留作在个性化风险分层监测中进行有针对性的使用。本综述评估了支持根据风险组对结直肠腺瘤患者进行个性化监测方案的证据，并比较了监测性结肠镜检查与替代预防策略的有效性。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。
