Abstract
The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Here we adopt nasopharyngeal carcinoma as the study model to establish an approach to surveillance that balances the effectiveness of disease detection versus costs. A total of 7,043 newly-diagnosed patients are grouped according to a clinic-molecular risk grouping system. We use a random survival forest model to simulate the monthly probability of disease recurrence, and thereby establish risk-based surveillance arrangements that can maximize the efficacy of recurrence detection per visit. Markov decision-analytic models further validate that the risk-based surveillance outperforms the control strategies and is the most cost-effective. These results are confirmed in an external validation cohort. Finally, we recommend the risk-based surveillance arrangement which requires 10, 11, 13 and 14 visits for group I to IV. Our surveillance strategies might pave the way for individualized and economic surveillance for cancer survivors.
Highlights
The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored
We take nasopharyngeal carcinoma (NPC) as the study model as: (i) NPC is endemic in Southeast Asia, with agestandardized rate of 3.0 per 100,000 in China;[4] costeffective surveillance strategy is essentially important to reduce patient costs in those developing countries. (ii) Our cancer center treats more than 4000 newly-diagnosed NPC patients per year
We have established a NPC disease-specific big-data intelligence research platform since 20155, which included over 50,000 NPC cases with high-quality follow-up information; greatly facilitated this large-scale, population-based research. (iii) Nasopharynx cancer is sensitive to radiotherapy and chemotherapy; early-stage recurrent disease or oligometastatic lesions were able to achieve favorable survival outcomes6. (iv) The National Comprehensive Cancer Network (NCCN) for head and neck cancer recommended uniform follow-up strategy across all NPC patients[7], whereas survival outcomes of this disease were heterogeneous and significantly varied among different stages
Summary
The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Oncological surveillance practice guidelines, based largely upon expert opinion, recommend that cancer survivors receive regular posttreatment surveillance (i.e., repeated physical, hematological, and radiological examinations averagely every 3–6 months) to facilitate early detection of disease recurrence[1,2,3]. This strategy has been proved to be effective to improve prognosis in multiple cancer types, as early detected recurrent lesions are more responsive to salvaged therapies. The model is established in the context of NPC, our method of modeling risk-based surveillance may be applicable for the development of cost-effective surveillance strategies for other diseases, and could assist in shaping individualized, risk-based posttreatment follow-up for the cancer survivors in general
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