Lead-time bias in esophageal cancer screening in high-risk areas in China  

作　　者：Zhao Yang Irene OL Wong Wei Deng Ru Chen Jiachen Zhou Wenqiang Wei 

机构地区：[1]School of Public Health,Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong 999077,China [2]Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Radiation Oncology,Peking University Cancer Hospital&Institute,Beijing 100142,China [3]Cancer Registry Office,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China [4]Department of Epidemiology and Biostatistics,School of Public Health,Xi'an Jiaotong University Health Science Center,Xi'an 710061,China [5]Department of Cancer Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China

出　　处：《Chinese Journal of Cancer Research》2020年第4期467-475,共9页中国癌症研究（英文版）

摘　　要：Objective:To investigate what extent lead-time bias is likely to affect endoscopic screening effectiveness for esophageal cancer in the high-risk area in China.Methods:A screening model based on the epidemiological cancer registry data,yielding a population-level incidence and mortality rates,was carried out to simulate study participants in the high-risk area in China,and investigate the effect of lead-time bias on endoscopic screening with control for length bias.Results:Of 100,000 participants,6,150(6.15%)were diagnosed with esophageal squamous dysplasia during the 20-year follow-up period.The estimated lead time ranged from 1.67 to 5.78 years,with a median time of 4.62 years[interquartile range(IQR):4.07-5.11 years]in the high-risk area in China.Lead-time bias exaggerated screening effectiveness severely,causing more than a 10%overestimation in 5-year cause-specific survival rate and around a 43%reduction in cause-specific hazard ratio.The magnitude of lead-time bias on endoscopic screening for esophageal cancer varied depending on the screening strategies,in which an inverted U-shaped and U-shaped effects were observed in the 5-year cause-specific survival rate and cause-specific hazard ratio respectively concerning a range of ages for primary screening.Conclusions:Lead-time bias,usually causing an overestimation of screening effectiveness,is an elementary and fundamental issue in cancer screening.Quantification and correction of lead-time bias are essential when evaluating the effectiveness of endoscopic screening in the high-risk area in China.

关 键 词：Esophageal cancer lead-time bias length bias SCREENING simulation model 

分 类 号：R735.1[医药卫生—肿瘤]