van Wifferen Francine, Greuter Marjolein J E, van Leerdam Monique E, Spanier Marcel B W, Dekker Evelien, Vasen Hans F A, Lansdorp-Vogelaar Iris, Canfell Karen, Meijer Gerrit A, Bisseling Tanya M, Hoogerbrugge Nicoline, Coupé Veerle M H
Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands.
Decision Modeling Center, Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, The Netherlands.
Gastroenterology. 2025 Jan;168(1):136-149. doi: 10.1053/j.gastro.2024.08.025. Epub 2024 Aug 28.
BACKGROUND & AIMS: The authors assessed whether familial colorectal cancer (FCRC) surveillance in individuals without hereditary CRC can be optimized METHODS: The Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA)-FCRC model simulates CRC development in individuals with a family history of CRC at 2-fold and 4-fold increased CRC risk compared with the general population. The authors simulated a strategy without surveillance, the current Dutch guideline (5-yearly colonoscopy between ages 45 and 75 years), and the following 3 sets of alternative strategies: colonoscopy surveillance, surveillance combining colonoscopy and fecal immunochemical testing (FIT), and FIT-based surveillance. Each set included a range of strategies differing in age range and test interval. The optimal strategy was defined as the strategy with highest quality-adjusted life-years (QALYs) satisfying all of the following criteria: in the (near-)efficiency area of the cost-effectiveness frontier and compared with current surveillance; noninferior effectiveness; no substantial increase in colonoscopy burden; and not more expensive.
The optimal strategy was 10-yearly colonoscopy with 2-yearly FIT between colonoscopies from ages 40 to 80 years for both 2-fold and 4-fold increased CRC risk. At 2-fold risk, this strategy prevented 0.8 more CRC deaths, gained 15.8 more QALYs at 731 fewer colonoscopies, and saved €98,000 over the lifetime of 1000 individuals compared with current surveillance. At 4-fold risk, figures were 2.1 more CRC deaths prevented, 37.0 more QALYs gained at 567 fewer colonoscopies, and €127,000 lower costs. Current surveillance was not (near-)efficient.
FIT could play an important role in FCRC surveillance. Surveillance with 10-yearly colonoscopy and 2-yearly FIT between colonoscopies from ages 40 to 80 years increased QALYs and reduced colonoscopy burden and costs compared with current FCRC surveillance.
作者评估了在无遗传性结直肠癌的个体中，家族性结直肠癌（FCRC）监测是否可以优化。
结直肠癌的腺瘤和锯齿状途径（ASCCA）-FCRC模型模拟了与普通人群相比，结直肠癌风险增加2倍和4倍且有结直肠癌家族史个体的结直肠癌发展情况。作者模拟了一种不进行监测的策略、当前荷兰指南（45至75岁之间每5年进行一次结肠镜检查）以及以下3组替代策略：结肠镜监测、结肠镜检查与粪便免疫化学检测（FIT）相结合的监测以及基于FIT的监测。每组都包括一系列在年龄范围和检测间隔上不同的策略。最佳策略被定义为具有最高质量调整生命年（QALY）且满足以下所有标准的策略：处于成本效益前沿的（接近）效率区域且与当前监测相比；有效性非劣效；结肠镜检查负担无大幅增加；且成本不更高。
对于结直肠癌风险增加2倍和4倍的情况，最佳策略均为40至80岁之间每10年进行一次结肠镜检查，并在两次结肠镜检查之间每2年进行一次FIT。在风险增加2倍时，与当前监测相比，该策略可预防多0.8例结直肠癌死亡，在结肠镜检查减少731次的情况下多获得15.8个QALY，并在1000名个体的一生中节省98,000欧元。在风险增加4倍时，相应数字为多预防2.1例结直肠癌死亡，结肠镜检查减少567次的情况下多获得37.0个QALY，且成本降低127,000欧元。当前监测不（接近）有效。
FIT在FCRC监测中可发挥重要作用。与当前FCRC监测相比，40至80岁之间每10年进行一次结肠镜检查并在两次结肠镜检查之间每2年进行一次FIT的监测可增加QALY，减少结肠镜检查负担和成本。
