Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates
Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates
复制标题
DOI：
10.1016/j.jclinepi.2011.06.011
复制
发表时间：
2011-12-01
影响因子：
7.2
通讯作者：
Etzioni, Ruth
中科院分区：
文献类型：
--
作者：
Gulati, Roman;Mariotto, Angela B.;Etzioni, Ruth
目的：预测欧洲和美国通过前列腺特异性抗原 (PSA) 筛查预防前列腺癌死亡所需筛查人数 (NNS) 和额外治疗人数 (NNT) 的长期估计。 研究设计和设置：提出了筛查和未筛查男性疾病特异性死亡的数学模型，给出了过度诊断、未筛查情况下的疾病特异性生存、筛查效果和其他原因死亡率的信息。使用模拟框架纳入相互竞争的死亡原因。 结果：假设过度诊断和筛查效果与欧洲前列腺癌筛查随机研究 (ERSPC) 结果一致，我们预计 25 年后，需要对 262 名男性进行筛查，并需要对另外 9 名男性进行筛查，以防止一名前列腺癌死亡。在与美国发病率一致的一系列过度诊断率下，NNS 和额外 NNT 的相应估计值为 186-220 和 2-5。结论：NNS 和额外 NNT 的长期估计值比 ERSPC 试验结果公布的短期估计值低一个数量级，并且可能与美国普通人群中具有成本效益的 PSA 筛查一致。 (C) 2011 Elsevier Inc. 保留所有权利。
Objective: To project long-term estimates of the number needed to screen (NNS) and the additional number needed to treat (NNT) to prevent one prostate cancer death with prostate-specific antigen (PSA) screening in Europe and in the United States.Study Design and Setting: A mathematical model of disease-specific deaths in screened and unscreened men given information on overdiagnosis, disease-specific survival in the absence of screening, screening efficacy, and other-cause mortality is presented. A simulation framework is used to incorporate competing causes of death.Results: Assuming overdiagnosis and screening efficacy consistent with European Randomized study of Screening for Prostate Cancer (ERSPC) results, we project that, after 25 years, 262 men need to be screened and nine additional men need to be screen detected to prevent one prostate cancer death. Corresponding estimates of the NNS and the additional NNT under a range of overdiagnosis rates that are consistent with U.S. incidence are 186-220 and 2-5.Conclusions: Long-term estimates of the NNS and the additional NNT are an order of magnitude lower than the short-term estimates published with the results of the ERSPC trial and may be consistent with cost-effective PSA screening in the general U.S. population. (C) 2011 Elsevier Inc. All rights reserved.