我们评估是否可以优化无遗传性 CRC 个体的家族性结直肠癌 (FCRC) 监测方法：ASCCA-FCRC 模型模拟有 CRC 家族史的个体的 CRC 发展，与未患 CRC 的个体相比，CRC 风险增加 2 倍和 4 倍。一般人群。我们模拟了一种没有监测的策略、当前的荷兰指南（45-75 之间每 5 年进行一次结肠镜检查）以及三组替代策略；结肠镜检查监测、结肠镜检查和粪便免疫化学检测（FIT）相结合的监测以及基于 FIT 的监测。每组都包括一系列年龄范围和测试间隔不同的策略。最佳策略被定义为具有最高质量调整生命年 (QALY) 且满足所有标准的策略：1) 在成本效益前沿的（接近）效率区域，并与当前监测相比 2) 非劣效，3）结肠镜检查负担没有显着增加，并且，4）不更昂贵。最佳策略是从 40 岁到 80 岁，每 10 年进行一次结肠镜检查，并在结肠镜检查之间每年进行 2 年 FIT，因为 CRC 风险增加了 2 倍和 4 倍。在 2 倍风险下，与当前监测相比，该策略可避免 0.8 例 CRC 死亡，将 QALY 提高 15.8 次，减少 731 次结肠镜检查，并在 1,000 人的一生中节省 98,000 欧元。在风险增加 4 倍的情况下，结直肠癌死亡人数减少 2.1 人，QALY 增加 37.0 人，结肠镜检查次数减少 567 次，成本降低 12.7 万欧元。当前的监测效率不高。FIT 可以在 FCRC 监测中发挥重要作用。与当前的 FCRC 监测相比，每 10 年进行一次结肠镜检查以及在 40 岁至 80 岁之间进行每两年一次结肠镜检查的监测可提高 QALY，并减少结肠镜检查负担和成本。版权所有 © 2024 AGA Institute。由爱思唯尔公司出版。保留所有权利。

We assessed whether familial colorectal cancer (FCRC) surveillance in individuals without hereditary CRC can be optimized METHODS: The ASCCA-FCRC model simulates CRC development in individuals with a family history of CRC at 2-fold and 4-fold increased CRC risk compared to the general population. We simulated a strategy without surveillance, the current Dutch guideline (5-yearly colonoscopy between 45-75), and three sets of alternative strategies; colonoscopy surveillance, surveillance combining colonoscopy and fecal immunochemical test (FIT) and FIT-based surveillance. Each set included a range of strategies differing in age range and test interval. The optimal strategy was defined as the strategy with highest quality-adjusted life years (QALYs) satisfying all criteria: 1) in the (near-)efficiency area of the cost-effectiveness frontier, and compared to current surveillance 2) non-inferior effectiveness, 3) no substantial increase in colonoscopy burden and, 4) not more expensive.The optimal strategy was 10-yearly colonoscopy with 2-yearly FIT between colonoscopies from age 40 to 80 for both 2- and 4-fold increased CRC risk. At 2-fold risk, this strategy prevented 0.8 more CRC deaths, gained 15.8 more QALYs at 731 fewer colonoscopies and saved €98k over the lifetime of 1,000 individuals compared to current surveillance. At 4-fold risk, figures were 2.1 more CRC deaths prevented, 37.0 more QALYs gained at 567 fewer colonoscopies and €127k lower costs. Current surveillance was not (near-)efficient.FIT could play an important role in FCRC surveillance. Surveillance with 10-yearly colonoscopy and 2-yearly FIT between colonoscopies from age 40 to 80 increases QALYs and reduces colonoscopy burden and costs compared to current FCRC surveillance.Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.