Does Finasteride Affect the Severity of Prostate Cancer? A Causal Sensitivity Analysis.
Does Finasteride Affect the Severity of Prostate Cancer? A Causal Sensitivity Analysis.
复制标题
DOI：
10.1198/016214508000000706
复制
发表时间：
2008-12-01
影响因子：
3.7
通讯作者：
Ankerst DP
中科院分区：
文献类型：
--
作者：
Shepherd BE;Redman MW;Ankerst DP
2003年，Thompson和他的同事报告说，与安慰剂相比，每天使用芬那鲁德可使前列腺癌的患病率降低25%。这些结果是基于双盲随机前列腺癌预防试验（PCPT），该试验每年随访18，882名既往或当前无前列腺癌指征的男性，持续7年。然而，对化学预防剂降低风险和在临床实践中采用其的热情，在试验中发现，高级别的绝对数量增加，（Gleason评分≥ 7）问题是，这一发现是否真的意味着芬布地增加了患更严重前列腺癌的风险，或者是由于一系列可能的随机化后选择偏倚，包括治疗组之间癌症病例患者特征的差异、因芬那肽治疗下前列腺特异性抗原敏感性增加而导致的癌症状态活检验证差异、因芬那肽减少前列腺体积而导致的活检分级差异以及不可解释的脱落。通过实施逆概率加权估计方程的因果推理方法，该分析通过估计非那肽与安慰剂之间前列腺癌严重程度的平均治疗差异，解决了非那肽是否导致更严重的前列腺癌的问题，主要分层的受试者可能发生前列腺癌，无论治疗分配如何。我们进行了敏感性分析，依次调整了PCPT中列出的许多潜在的随机化后偏倚。
In 2003 Thompson and colleagues reported that daily use of finasteride reduced the prevalence of prostate cancer by 25% compared to placebo. These results were based on the double-blind randomized Prostate Cancer Prevention Trial (PCPT) which followed 18,882 men with no prior or current indications of prostate cancer annually for seven years. Enthusiasm for the risk reduction afforded by the chemopreventative agent and adoption of its use in clinical practice, however, was severely dampened by the additional finding in the trial of an increased absolute number of high-grade (Gleason score ≥ 7) cancers on the finasteride arm. The question arose as to whether this finding truly implied that finasteride increased the risk of more severe prostate cancer or was a study artifact due to a series of possible post-randomization selection biases, including differences among treatment arms in patient characteristics of cancer cases, differences in biopsy verification of cancer status due to increased sensitivity of prostate-specific antigen under finasteride, differential grading by biopsy due to prostate volume reduction by finasteride, and nonignorable drop-out. Via a causal inference approach implementing inverse probability weighted estimating equations, this analysis addresses the question of whether finasteride caused more severe prostate cancer by estimating the mean treatment difference in prostate cancer severity between finasteride and placebo for the principal stratum of participants who would have developed prostate cancer regardless of treatment assignment. We perform sensitivity analyses that sequentially adjust for the numerous potential post-randomization biases conjectured in the PCPT.
登录
查看更多内容
影响因子：
3.7
作者：
Dawid, AP
通讯作者：
Dawid, AP
DOI：
10.2307/2981697
发表时间：
1984-01-01
影响因子：
2
作者：
ROSENBAUM, PR
通讯作者：
ROSENBAUM, PR
影响因子：
158.5
作者：
Thompson, IM;Goodman, PJ;Coltman, CA
通讯作者：
Coltman, CA
影响因子：
1.8
作者：
Shepherd, Bryan E.;Gilbert, Peter B.;Mehrotra, Devan V.
通讯作者：
Mehrotra, Devan V.
影响因子：
4.5
作者：
RUBIN, DB
通讯作者：
RUBIN, DB