Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
Cancer Epidemiol Biomarkers Prev. 2022 Dec 5;31(12):2157-2168. doi: 10.1158/1055-9965.EPI-22-0019.
Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy (IRT) and/or procarbazine have an increased risk of developing colorectal cancer. We investigated the cost-effectiveness of colorectal cancer surveillance in Dutch Hodgkin lymphoma survivors to determine the optimal surveillance strategy for different Hodgkin lymphoma subgroups.
The Microsimulation Screening Analysis-Colon model was adjusted to reflect colorectal cancer and other-cause mortality risk in Hodgkin lymphoma survivors. Ninety colorectal cancer surveillance strategies were evaluated varying in starting and stopping age, interval, and modality [colonoscopy, fecal immunochemical test (FIT, OC-Sensor; cutoffs: 10/20/47 μg Hb/g feces), and multi-target stool DNA test (Cologuard)]. Analyses were also stratified per primary treatment (IRT and procarbazine or procarbazine without IRT). Colorectal cancer deaths averted (compared with no surveillance) and incremental cost-effectiveness ratios (ICER) were primary outcomes. The optimal surveillance strategy was identified assuming a willingness-to-pay threshold of €20,000 per life-years gained (LYG).
Overall, the optimal surveillance strategy was annual FIT (47 μg) from age 45 to 70 years, which might avert 70% of colorectal cancer deaths in Hodgkin lymphoma survivors (compared with no surveillance; ICER:€18,000/LYG). The optimal surveillance strategy in Hodgkin lymphoma survivors treated with procarbazine without IRT was biennial FIT (47 μg) from age 45 to 70 years (colorectal cancer mortality averted 56%; ICER:€15,000/LYG), and when treated with IRT and procarbazine, annual FIT (47 μg) surveillance from age 40 to 70 was most cost-effective (colorectal cancer mortality averted 75%; ICER:€13,000/LYG).
Colorectal cancer surveillance in Hodgkin lymphoma survivors is cost-effective and should commence earlier than screening occurs in population screening programs. For all subgroups, FIT surveillance was the most cost-effective strategy.
Colorectal cancer surveillance should be implemented in Hodgkin lymphoma survivors.
接受盆腔放疗（IRT）和/或洛莫司汀治疗的霍奇金淋巴瘤幸存者患结直肠癌的风险增加。我们研究了荷兰霍奇金淋巴瘤幸存者结直肠癌监测的成本效益，以确定不同霍奇金淋巴瘤亚组的最佳监测策略。
调整了 MicroScreening Screening Analysis-Colon 模型，以反映霍奇金淋巴瘤幸存者的结直肠癌和其他原因死亡率风险。评估了 90 种结直肠癌监测策略，这些策略在起始和停止年龄、间隔和方式（结肠镜检查、粪便免疫化学试验（FIT，OC-Sensor；截止值：10/20/47 μg Hb/g 粪便）和多靶标粪便 DNA 试验（Cologuard））方面有所不同。分析还按主要治疗（IRT 和洛莫司汀或无 IRT 的洛莫司汀）进行分层。主要结果是避免的结直肠癌死亡（与无监测相比）和增量成本效益比（ICER）。假设每获得一个生命年（LYG）的意愿支付阈值为 20,000 欧元，确定了最佳监测策略。
总体而言，最佳监测策略是 45 岁至 70 岁时每年进行 FIT（47μg），这可能会使霍奇金淋巴瘤幸存者的结直肠癌死亡人数减少 70%（与无监测相比；ICER：每获得一个 LYG 的成本为 18,000 欧元）。未接受 IRT 治疗的洛莫司汀治疗的霍奇金淋巴瘤幸存者的最佳监测策略是 45 岁至 70 岁时每两年进行一次 FIT（47μg）（结直肠癌死亡率降低 56%；ICER：每获得一个 LYG 的成本为 15,000 欧元），而接受 IRT 和洛莫司汀治疗的患者，40 岁至 70 岁时每年进行一次 FIT（47μg）监测是最具成本效益的策略（结直肠癌死亡率降低 75%；ICER：每获得一个 LYG 的成本为 13,000 欧元）。
霍奇金淋巴瘤幸存者的结直肠癌监测具有成本效益，应早于人群筛查计划中的筛查开始。对于所有亚组，FIT 监测都是最具成本效益的策略。
应在霍奇金淋巴瘤幸存者中实施结直肠癌监测。
