Screening Based on the Risk of Cancer Calculation From Bayesian Hierarchical Changepoint and Mixture Models of Longitudinal Markers
基于纵向标志物贝叶斯层级变点与混合模型的癌症风险筛查AI 解读 ↓
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基于纵向标志物贝叶斯层级变点与混合模型的癌症风险筛查
- 研究问题
- 相较统一的标志物参考阈值，如何利用个体纵向CA125轨迹计算卵巢癌后验风险，并据此制定与评价筛查策略？
- 方法与思路
- 作者对英国试验的病例与对照轨迹建立层级变点及混合模型，以MCMC计算后验风险，并使用独立瑞典试验评价策略。
- 材料陈述的贡献
- 摘要称，提出基于纵向CA125风险的筛查策略；前瞻试验模拟提示，在给定特异度下敏感度可能显著提高。
- 阅读关注点
- 应核对病例与对照轨迹模型、风险计算的校准和阈值选择，以及独立试验评价与前瞻模拟分别支持哪些结论。
- 阅读边界
- 来源为稿件版本未注明的OpenAlex索引摘要；敏感度改善属于模拟中的潜在收益，不能据此判断真实筛查对死亡率的影响。
原文摘要
The standard approach to early detection of disease with a quantitative marker is to set a population-based fixed reference level for making further individual screening or referral decisions. For many types of disease, including prostate and ovarian cancer, additional information is contained in the subject-specific temporal behavior of the marker, which exhibits a characteristic alteration early in the course of the disease. In this article we derive a Bayesian approach to screening based on calculation of the posterior probability of disease given longitudinal marker levels. The method is motivated by a randomized ovarian cancer screening trial in the United Kingdom comprising 22,000 women screened over 4 years with an additional 5 years of follow-up on average. Levels of the antigen CA125 were recorded annually in the screened arm. CA125 profiles of cases and controls from the U.K. trial are modeled using hierarchical changepoint and mixture models, posterior distributions are calculated using Markov chain Monte Carlo methods, and the model is used to calculate the Bayesian posterior risk of having ovarian cancer given a new subject's single or multiple longitudinal CA125 levels. A screening strategy based on the risk calculation is then evaluated using data from an independent screening trial of 5,550 women performed in Sweden. A longitudinal CA125 screening strategy based on calculation of the risk of ovarian cancer is proposed. Simulations of a prospective trial using a strategy based on the risk calculated from longitudinal CA125 values indicate potentially large increases in sensitivity for a given specificity compared to the standard approach based on a fixed CA125 reference level for all subjects.