Lu Bin, Wang Le, Lu Ming, Zhang Yuhan, Cai Jie, Luo Chenyu, Chen Hongda, Dai Min
Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Apr 22;12:883401. doi: 10.3389/fonc.2022.883401. eCollection 2022.
A microsimulation model provides important references for decision-making regarding colorectal cancer (CRC) prevention strategies, yet such a well-validated model is scarce in China.
We comprehensively introduce the development of MIcrosimulation Model for the prevention and Intervention of Colorectal Cancer in China (MIMIC-CRC). The MIMIC-CRC was first constructed to simulate the natural history of CRC based on the adenoma-carcinoma pathway. The parameters were calibrated and validated using data from population-based cancer registry data and CRC screening programs. Furthermore, to assess the model's external validity, we compared the model-derived results to outcome patterns of a sigmoidoscopy screening trial in the UK [UK Flexible Sigmoidoscopy Screening (UKFSS) trial]. Finally, we evaluated the application potential of the MIMIC-CRC model in CRC screening by comparing the 8 different strategies.
We found that most of the model-predicted colorectal lesion prevalence was within the 95% CIs of observed prevalence in a large population-based CRC screening program in China. In addition, model-predicted sex- and age-specific CRC incidence and mortality were equivalent to the registry-based data. The hazard ratios of model-estimated CRC-related incidence and mortality for sigmoidoscopy screening compared to no screening were 0.60 and 0.51, respectively, which were comparable to the reported results of the UKFSS trial. Moreover, we found that all 8 strategies could reduce CRC incidence and mortality compared to no screening.
The well-calibrated and validated MIMIC-CRC model may represent a valid tool to assess the comparative effectiveness of CRC screening strategies and will be useful for further decision-making to CRC prevention.
微观模拟模型为结直肠癌（CRC）预防策略的决策提供了重要参考，但在中国，这样经过充分验证的模型却很稀缺。
我们全面介绍了中国结直肠癌预防与干预微观模拟模型（MIMIC-CRC）的开发过程。MIMIC-CRC最初是基于腺瘤-癌途径构建的，用于模拟结直肠癌的自然史。使用基于人群的癌症登记数据和结直肠癌筛查项目的数据对参数进行了校准和验证。此外，为了评估该模型的外部有效性，我们将模型得出的结果与英国一项乙状结肠镜筛查试验[英国柔性乙状结肠镜筛查（UKFSS）试验]的结果模式进行了比较。最后，我们通过比较8种不同策略，评估了MIMIC-CRC模型在结直肠癌筛查中的应用潜力。
我们发现，在中国一项基于人群的大型结直肠癌筛查项目中，模型预测的大多数结直肠病变患病率处于观察到的患病率的95%置信区间内。此外，模型预测的特定性别和年龄的结直肠癌发病率和死亡率与基于登记处的数据相当。与未筛查相比，模型估计的乙状结肠镜筛查的结直肠癌相关发病率和死亡率的风险比分别为0.60和0.51，这与UKFSS试验报告的结果相当。此外，我们发现与未筛查相比，所有8种策略都可以降低结直肠癌的发病率和死亡率。
经过良好校准和验证的MIMIC-CRC模型可能是评估结直肠癌筛查策略比较有效性的有效工具，将有助于结直肠癌预防的进一步决策。
