Extended follow-up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial
Extended follow-up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial
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DOI：
10.1111/bju.14580
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发表时间：
2019-05-01
影响因子：
4.5
通讯作者：
Andriole, Gerald
中科院分区：
文献类型：
--
作者：
Pinsky, Paul F.;Miller, Eric;Andriole, Gerald
目的 在随机前列腺癌、肺癌、结直肠癌和卵巢癌 (PLCO) 癌症筛查试验中检查各组前列腺癌 (PCa) 的发病率和死亡率。患者和方法 1993 年至 2001 年间，10 个筛查中心年龄 55-74 岁的患者被随机分配至干预组或常规护理组。干预组的患者每年接受六次前列腺特异性抗原（PSA）测试和四次直肠指检。通过积极的随访过程以及与州癌症登记处和国家死亡指数的联系，对患者的前列腺癌发病率和死亡率进行随访。对于通过积极随访发现的癌症，试验摘要者记录了诊断模式（屏幕检测、症状、其他）。结果 共有 38 340 名患者被随机分配至干预组，38 343 名患者被随机分配至常规护理组。死亡率的中位随访时间为 16.9 年（干预）和 16.7 年（常规护理）。共有 333 例（干预）和 352 例（常规护理）PCa 癌症死亡，死亡率（每 10000 人年）分别为 5.5 和 5.9，比率 (RR) 为 0.93（95% 置信区间 [CI] 0.81-1.08；P = 0.38）。 PCa 总体发病率的 RR 为 1.05 (95% CI 1.01-1.09)。按格里森类别划分的 RR：格里森 2-6 疾病为 1.17 (95% CI 1.11-1.23)，格里森 7 疾病为 1.00 (95% CI 0.93-1.07)，格里森 8-10 疾病为 0.89 (95% CI 0.80-0.99)。从检测方式来看，在试验的筛查阶段，干预组有 13% 的病例出现症状，而常规护理组有 27% 的病例出现症状；筛选后，每组的百分比均为 18%。结论 经过近 17 年的中位随访，与常规护理组相比，干预组的 PCa 死亡率没有显着降低。与常规护理组相比，干预组中格里森 2-6 型疾病显着增加，格里森 8-10 型疾病显着减少。
Objective To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Patients and Methods Patients aged 55-74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual care arm. Patients in the intervention arm received six annual prostate-specific antigen (PSA) tests and four annual digital rectal examinations. The patients were followed for PCa incidence and for mortality via active follow-up processes and by linkage to state cancer registries and the National Death Index. For cancers identified through active follow-up, trial abstractors recorded the mode of diagnosis (screen-detected, symptomatic, other). Results A total of 38 340 patients were randomized to the intervention arm and 38 343 to a usual care arm. The median follow-up for mortality was 16.9 (intervention) and 16.7 years (usual care). There were 333 (intervention) and 352 (usual care) PCa cancer deaths, giving rates (per 10 000 person-years) of 5.5 and 5.9, respectively, and a rate ratio (RR) of 0.93 (95% confidence interval [CI] 0.81-1.08; P = 0.38). The RR for overall PCa incidence was 1.05 (95% CI 1.01-1.09). The RRs by Gleason category were 1.17 (95% CI 1.11-1.23) for Gleason 2-6, 1.00 (95% CI 0.93-1.07) for Gleason 7 and 0.89 (95% CI 0.80-0.99) for Gleason 8-10 disease. By mode of detection, during the trial's screening phase, 13% of intervention arm vs 27% of usual care arm cases were symptomatic; post-screening, these percentages were 18% in each arm. Conclusion After almost 17 years of median follow-up, there was no significant reduction in PCa mortality in the intervention compared with the usual care arm. There was a significant increase in Gleason 2-6 disease and a significant reduction in Gleason 8-10 disease in the intervention compared with the usual care arm.