Disease-specific mortality may underestimate the total effect of prostate cancer screening
Disease-specific mortality may underestimate the total effect of prostate cancer screening
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DOI：
10.1258/jms.2010.010074
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发表时间：
2010-01-01
影响因子：
2.9
通讯作者：
Schroder, Fritz H.
中科院分区：
文献类型：
--
作者：
van Leeuwen, Pim J.;Kranse, Ries;Schroder, Fritz H.
目的研究欧洲前列腺癌筛查随机研究鹿特丹部分中疾病特异性死亡率和超额死亡率之间的差异。超额死亡人数定义为截至2006年12月31日前列腺癌（PC）患者观察到的死亡人数与预期死亡人数之间的差异。预期数量来自所有研究参与者在可能诊断为PC之前的死亡率。疾病特异性死亡率基于死于PC的男性人数。结果干预组和对照组的总死亡率无显著差异：RR 1.02（95%CI 0.98-1.07）。干预组的疾病特异性死亡率为0.42例男性/1000人年，对照组为0.48例男性/1000人年：RR 0.86（95% CI 0.64-1.17）。干预组的超额死亡率为0.40/1000人-年，对照组为0.61/1000人-年，超额死亡率的RR为0.66（95%CI 0.39-1.13）。这一观察结果可能是由于系统性低估了疾病特异性死亡，和/或通过超额死亡率分析而不是疾病特异性死亡率测量的额外疾病相关死亡率。
Objectives To study the difference between the disease-specific and excess mortality rate in the European Randomized Study of Screening for Prostate Cancer section Rotterdam.Methods A total of 42,376 men were randomized to systematic screening or usual care. The excess number of deaths was defined as the difference between the observed number of deaths in the prostate cancer (PC) patients and the expected number of deaths up to 31 December 2006. The expected number was derived from mortality of all study participants before a possible diagnosis with PC. The disease-specific mortality rate was based on the number of men who died from PC. The excess mortality rate based on the arm-specific excess number of deaths and the disease-specific mortality rate were compared between the two study arms.Results The overall mortality rate was not significantly different between the intervention and the control arms of the study: RR 1.02 (95% CI 0.98-1.07). The disease-specific mortality rate was 0.42 men per 1000 person-years in the intervention and 0.48 men per 1000 person-years in the control arm: RR 0.86 (95% CI 0.64-1.17). The excess mortality rate was 0.40 per 1000 person-years in the intervention arm and 0.61 men per 1000 person-years in the control arm, and the RR for excess mortality was 0.66 (95% CI 0.39-1.13).Conclusions In contrast to the disease-specific mortality rates an increased difference in the excess mortality rates was observed between the two arms. This observation may be due to a systematic underestimation of the disease-specific deaths, and/or an additional disease-related mortality that is measured by an excess mortality analysis but not by a disease-specific mortality.