Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, United States.
Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, United States.
Gynecol Oncol. 2018 Apr;149(1):117-120. doi: 10.1016/j.ygyno.2018.01.029. Epub 2018 Feb 15.
To measure the effectiveness of ovarian cancer screening using the Risk of Ovarian Cancer Algorithm (ROCA).
A Markov model was constructed based on the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). This model was used to predict the outcome of ovarian cancer screening with ROCA.
The model predicted the ovarian cancer mortality from age 50 to age 85 to be 0.954% with a decrease in life expectancy of 0.178years (yrs) per person. Using data from the UKCTOCS the model predicted a similar reduction in mortality (11% vs. 10%), and similar curves for ovarian cancer mortality. Screening at age 50 for 20yrs reduced ovarian cancer mortality from 0.953% to 0.898%, an absolute decrease of 6%, yielding an increase in life expectancy of 0.0101yrs, preventing 55 deaths per 100,000 screened at a cost of $585,946 per life-yr. Screening for 30yrs reduced mortality from 0.954% to 0.872%, an absolute decrease of 9%, preventing 82 deaths at a cost of $763,970 per life-yr.
The ROCA test can improve the detection of early ovarian cancer but is not practical for screening in an average-risk population. We predict the ROCA test will reduce overall ovarian cancer mortality by 6% to 9% but at a substantial cost. For ROCA to be practical, the cost would need to be reduced ten-fold and would have only a marginal impact on mortality from ovarian cancer. This model supports the FDA's criticism of the ROCA test. Ovarian cancer screening may reduce mortality from ovarian cancer but is not cost effective.
使用卵巢癌风险算法（ROCA）衡量卵巢癌筛查的效果。
基于英国卵巢癌筛查协作试验（UKCTOCS）构建了一个马尔可夫模型。该模型用于预测 ROCA 卵巢癌筛查的结果。
该模型预测从 50 岁到 85 岁的卵巢癌死亡率为 0.954%，每人的预期寿命减少 0.178 年（yrs）。使用 UKCTOCS 的数据，该模型预测死亡率相似降低（11%对 10%），并且卵巢癌死亡率曲线相似。50 岁开始筛查 20 年可使卵巢癌死亡率从 0.953%降低至 0.898%，绝对降低 6%，预期寿命延长 0.0101 年，每 10 万人筛查可预防 55 例死亡，成本为每人每年 585946 美元。筛查 30 年可使死亡率从 0.954%降低至 0.872%，绝对降低 9%，每 10 万人筛查可预防 82 例死亡，成本为每人每年 763970 美元。
ROCA 测试可以提高早期卵巢癌的检出率，但对于一般风险人群的筛查并不实用。我们预测 ROCA 测试将使整体卵巢癌死亡率降低 6%至 9%，但成本巨大。要使 ROCA 测试实用，成本需要降低十倍，并且对卵巢癌死亡率的影响仅略有边际。该模型支持 FDA 对 ROCA 测试的批评。卵巢癌筛查可能会降低卵巢癌的死亡率，但不具有成本效益。
