鼻咽癌筛查中应用 Epstein-Barr 病毒聚合酶链反应或血清学检测的成本效果评价：全球高发地区人群研究

Cost-Effectiveness of Nasopharyngeal Carcinoma Screening With Epstein-Barr Virus Polymerase Chain Reaction or Serology in High-Incidence Populations Worldwide.

机构信息

Department of Radiation Oncology, Stanford University, Stanford, CA, USA.

Department of Pathology, Stanford University, Stanford, CA, USA.

出版信息

J Natl Cancer Inst. 2021 Jul 1;113(7):852-862. doi: 10.1093/jnci/djaa198.

DOI:10.1093/jnci/djaa198

PMID:33351145

Abstract

BACKGROUND

The incidence of endemic Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) varies considerably worldwide. In high-incidence regions, screening trials have been conducted. We estimated the mortality reduction and cost-effectiveness of EBV-based NPC screening in populations worldwide.

METHODS

We identified 380 populations in 132 countries with incident NPC and developed a decision-analytic model to compare 10 unique onetime screening strategies with no screening for men and women aged 50 years. Screening performance and the stage distribution of undiagnosed NPC were derived from a systematic review of prospective screening trials.

RESULTS

Screening was cost-effective in up to 14.5% of populations, depending on the screening strategy. These populations were limited to East Asia, Southeast Asia, and North Africa or were Asian, Pacific Islander, or Inuit populations in North America. A combination of serology and nasopharyngeal polymerase chain reaction was most cost-effective, but other combinations of serologic and/or plasma polymerase chain reaction screening were also cost-effective. The estimated reduction in NPC mortality was similar across screening strategies. For a hypothetical cohort of patients in China, the 10-year survival improved from 71.0% (95% confidence interval = 68.8% to 73.0%) without screening to a median of 86.3% (range = 83.5%-88.2%) with screening. This corresponded to a median 10-year reduction in NPC mortality of 52.9% (range = 43.1%-59.3%). Screening interval affected absolute mortality reduction and cost-effectiveness.

CONCLUSIONS

We observed decreased NPC mortality with EBV-based screening. Screening was cost-effective in many high-incidence populations and could be extended to men and women as early as age 40 years in select regions. These findings may be useful when choosing among local public health initiatives.

摘要

背景

地方性 Epstein-Barr 病毒（EBV）相关鼻咽癌（NPC）的发病率在全球范围内差异很大。在高发地区已经开展了筛查试验。我们评估了基于 EBV 的 NPC 筛查在全球人群中的死亡率降低和成本效益。

方法

我们确定了全球 132 个国家/地区的 380 个 NPC 发病人群，并开发了一个决策分析模型，比较了 10 种独特的一次性筛查策略与 50 岁男性和女性不筛查的情况。筛查效果和未确诊 NPC 的分期分布来自对前瞻性筛查试验的系统评价。

结果

取决于筛查策略，筛查在高达 14.5%的人群中具有成本效益。这些人群仅限于东亚、东南亚和北非，或者是北美亚洲、太平洋岛民或因纽特人的人群。血清学和鼻咽聚合酶链反应（PCR）联合检测最具成本效益，但其他血清学和/或血浆 PCR 联合检测组合也具有成本效益。不同筛查策略的 NPC 死亡率降低估计相似。对于中国的一个假设患者队列，10 年生存率从无筛查的 71.0%（95%置信区间=68.8%至 73.0%）提高到筛查的中位数 86.3%（范围=83.5%至 88.2%）。这相当于 NPC 死亡率中位数降低了 52.9%（范围=43.1%至 59.3%）。筛查间隔影响绝对死亡率降低和成本效益。