Tsukamoto Fumio, Tsukamoto Shunsuke, Kato Takeharu, Nagata Hiroshi, Takamizawa Yasuyuki, Moritani Konosuke, Kinugasa Yusuke, Esaki Minoru, Kanemitsu Yukihide, Igarashi Ataru
Department of Colorectal Surgery National Cancer Center Hospital Tokyo Japan.
Department of Gastrointestinal Surgery, Graduate School of Medicine Institute of Science Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2025 Jan 13;9(4):730-738. doi: 10.1002/ags3.12906. eCollection 2025 Jul.
The optimal postoperative surveillance strategy after curative resection in patients with stage IV colorectal cancer remains unclear. The present study aimed to assess the cost-effectiveness of postoperative surveillance strategies recommended by the various academic societies for stage IV colorectal cancer after curative resection.
This economic evaluation used a Markov state-transition model to compare the cost-effectiveness of postoperative surveillance programs proposed in guidelines published by the American Society of Clinical Oncology, American Society of Colon and Rectal Surgeons, European Society for Medical Oncology, National Comprehensive Cancer Network, and Japanese Society for Cancer of the Colon and Rectum. Model parameters were extracted from our retrospective data for patients with colorectal cancer who had synchronous liver and/or lung metastases and underwent curative resection. Cost-effectiveness was assessed using an incremental cost-effectiveness ratio for quality-adjusted life years, with a maximum acceptable value of 5 000 000-6 000 000 JPY/33333-40 000 USD. Uncertainty in the model was assessed by probabilistic sensitivity analyses.
For patients with stage IV colorectal cancer after curative resection, the JSCCR-strategy was the most cost-effective, with an incremental cost-effectiveness ratio of 2 888 628 JPY/19256 USD compared with the next most cost-effective program. Probabilistic sensitivity analysis showed that the JSCCR-strategy was most likely to be selected as the most cost-effective (76.1%-77.9%).
This modeling analysis found that the JSCCR-strategy was the most cost-effective strategy for stage IV colorectal cancer. Our findings suggest that intensive postoperative surveillance is acceptable for stage IV colorectal cancer.
IV期结直肠癌患者根治性切除术后的最佳术后监测策略仍不明确。本研究旨在评估各学术团体推荐的IV期结直肠癌根治性切除术后监测策略的成本效益。
本经济评估采用马尔可夫状态转移模型，比较美国临床肿瘤学会、美国结直肠外科医师学会、欧洲医学肿瘤学会、国家综合癌症网络和日本结直肠癌学会发布的指南中提出的术后监测方案的成本效益。模型参数从我们对患有同步肝和/或肺转移并接受根治性切除的结直肠癌患者的回顾性数据中提取。使用质量调整生命年的增量成本效益比评估成本效益，最大可接受值为5000000 - 6000000日元/33333 - 40000美元。通过概率敏感性分析评估模型中的不确定性。
对于IV期结直肠癌根治性切除术后的患者，日本结直肠癌学会（JSCCR）的策略是最具成本效益的，与次最具成本效益的方案相比，增量成本效益比为2888628日元/19256美元。概率敏感性分析表明，JSCCR策略最有可能被选为最具成本效益的策略（76.1% - 77.9%）。
该建模分析发现，JSCCR策略是IV期结直肠癌最具成本效益的策略。我们的研究结果表明，IV期结直肠癌术后进行强化监测是可以接受的。
