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首页> 外文OA文献 >Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom collaborative trial of ovarian cancer screening
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Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom collaborative trial of ovarian cancer screening

机译：与英国卵巢癌筛查协作试验中的单阈值规则相比，使用序列生物标记测量的风险算法使筛查检测到的癌症数量翻倍

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PURPOSE: Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates. ududPATIENTS AND METHODS: In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 46,237 women, age 50 years or older underwent incidence screening by using the multimodal strategy (MMS) in which annual serum cancer antigen 125 (CA-125) was interpreted with the risk of ovarian cancer algorithm (ROCA). Women were triaged by the ROCA: normal risk, returned to annual screening; intermediate risk, repeat CA-125; and elevated risk, repeat CA-125 and transvaginal ultrasound. Women with persistently increased risk were clinically evaluated. All participants were followed through national cancer and/or death registries. Performance characteristics of a single-threshold rule and the ROCA were compared by using receiver operating characteristic curves. ududRESULTS: After 296,911 women-years of annual incidence screening, 640 women underwent surgery. Of those, 133 had primary invasive epithelial ovarian or tubal cancers (iEOCs). In all, 22 interval iEOCs occurred within 1 year of screening, of which one was detected by ROCA but was managed conservatively after clinical assessment. The sensitivity and specificity of MMS for detection of iEOCs were 85.8% (95% CI, 79.3% to 90.9%) and 99.8% (95% CI, 99.8% to 99.8%), respectively, with 4.8 surgeries per iEOC. ROCA alone detected 87.1% (135 of 155) of the iEOCs. Using fixed CA-125 cutoffs at the last annual screen of more than 35, more than 30, and more than 22 U/mL would have identified 41.3% (64 of 155), 48.4% (75 of 155), and 66.5% (103 of 155), respectively. The area under the curve for ROCA (0.915) was significantly (P = .0027) higher than that for a single-threshold rule (0.869). ududCONCLUSION: Screening by using ROCA doubled the number of screen-detected iEOCs compared with a fixed cutoff. In the context of cancer screening, reliance on predefined single-threshold rules may result in biomarkers of value being discarded.
机译：目的：癌症筛查策略通常采用单一生物标志物阈值来识别异常。我们调查了通过风险算法解释的系列生物标志物变化对癌症检出率的影响。 ud ud患者和方法：在英国卵巢癌筛查合作试验中，采用多模式策略（MMS）对46,237名年龄在50岁以上的女性进行了发病率筛查，其中每年血清癌抗原125（CA-125）为解释为具有卵巢癌算法（ROCA）的风险。 ROCA对妇女进行了分类：正常风险，返回年度筛查；中度危险，重复CA-125；并增加风险，重复CA-125和经阴道超声检查。临床风险不断增加的妇女。所有参与者均接受了国家癌症和/或死亡登记。通过使用接收器操作特征曲线比较了单阈值规则和ROCA的性能特征。结果：在296,911名妇女年的年度发病率筛查之后，有640名妇女接受了手术。在这些人中，有133人患有原发性浸润性上皮性卵巢癌或输卵管癌（iEOC）。在筛查的1年内总共发生了22次间隔性iEOC，其中ROCA检出了1次，但在临床评估后进行了保守治疗。 MMS检测iEOC的敏感性和特异性分别为85.8％（95％CI，79.3％至90.9％）和99.8％（95％CI，99.8％至99.8％），每个iEOC需进行4.8次手术。仅ROCA就检测到了87.1％（155个中的135个）iEOC。如果在上一个年度筛选中使用固定的CA-125截止值超过35、30和22 U / mL，则可以确定41.3％（155个中的64个），48.4％（155个中的75个）和66.5％（分别为155和103）。 ROCA的曲线下面积（0.915）显着（P = .0027）高于单阈值规则（0.869）。 ud ud结论：与固定截止值相比，使用ROCA进行的筛选使屏幕检测到的iEOC数量增加了一倍。在癌症筛查的背景下，对预定义的单阈值规则的依赖可能导致价值的生物标志物被丢弃。

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