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目的阐明在睾丸癌监测过程中终生辐射诱发癌风险评估的局限性,尤其是没有考虑辐射诱发癌的发生时间滞后于病人的生命周期。材料与方法本研究中CT辐射剂量测定数据的使用得到伦理委员会的批准,无须知情同意书,符合HIPAA。建立一个马尔科夫模型来评估睾丸癌病人睾丸切除术后10年中CT监测的预后。早期风险与滞后风险效应的定量化,睾丸癌病人预期减寿及生命死亡率风险与CT辐射诱发癌症相关风险的比较。不同于终生风险评估,预期减寿的推测涵盖了整个生命周期的时间风险,这使得终生风险评估的局限性得以显现。马氏链蒙特卡罗方法被用来评估结果的不确定性。结果以33岁精原细胞瘤Ⅰ期病人进行CT监测为例,睾丸癌生命死亡率风险[5.98×10-3;95%不确定区间(UI):302～894]仅稍高于辐射诱导癌风险(5.05×10-3;95%UI:280～730)。但是,归因于睾丸癌的预期减寿(83d;95%UI:42～124)比辐射诱导癌(24d;95%UI:13～35)大3倍。模拟情景的趋势是一致的。结论在做决策时,相对于短期的健康风险,终生辐射风险的评估可能过于强调了辐射诱发癌的风险。
OBJECTIVE: To elucidate the limitations of life-long radiation-induced cancer risk assessment during the testicular cancer test, especially without considering the timing of radiation-induced cancer lags behind the patient’s life cycle. Materials and Methods The use of CT radiation dosimetry in this study was approved by the Ethics Committee without the need for informed consent to be in line with HIPAA. Establish a Markov model to assess the prognosis of CT-monitoring in 10 years after orchiectomy in testicular cancer patients. Quantification of early and late risk effects, comparison of expected risk of life expectancy and life-threatening mortality in testicular cancer patients with CT-induced cancer risk. Unlike life-long risk assessments, the expectation of life-expectancy covers the time-to-risk of the entire life cycle, which makes the limitations of lifetime risk assessment visible. Markov chain Monte Carlo method was used to assess the uncertainty of the results. Results A 33-year-old patient with primary seminoma had CT monitoring. The risk of life-threatening testicular cancer (5.98 × 10-3; 95% Uncertainty interval (UI): 302 to 894) was only slightly higher than that of radiation-induced cancer Risk (5.05 × 10-3; 95% UI: 280 ~ 730). However, the expected life expectancy attributed to testicular cancer (83d; 95% UI: 42-124) is three times greater than radiation-induced cancer (24d; 95% UI: 13-35). The trend of simulated scenarios is consistent. Conclusion In making decisions, the assessment of lifelong radiation risks may over-emphasize the risk of radiation-induced cancer relative to short-term health risks.