Quality-of-life effects of prostate-specific antigen screening.
Quality-of-life effects of prostate-specific antigen screening.
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DOI：
10.1056/nejmoa1201637
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发表时间：
2012-08-16
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影响因子：
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通讯作者：
de Koning HJ
中科院分区：
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作者：
Heijnsdijk EA;Wever EM;Auvinen A;Hugosson J;Ciatto S;Nelen V;Kwiatkowski M;Villers A;Páez A;Moss SM;Zappa M;Tammela TL;Mäkinen T;Carlsson S;Korfage IJ;Essink-Bot ML;Otto SJ;Draisma G;Bangma CH;Roobol MJ;Schröder FH;de Koning HJ
欧洲前列腺癌筛查随机研究（ERSPC）报告11年后接受筛查的男性前列腺癌死亡率降低29%。然而，目前尚不清楚过度诊断和治疗对生活质量的危害在多大程度上抵消了这种益处。基于ERSPC随访数据，我们使用微模拟模型（MISCAN）来预测前列腺癌的数量、治疗、死亡和引入筛查后获得的质量调整生命年（QALYs）。各种筛选策略、疗效和生活质量假设进行了建模。我们预测，在55-69岁的年度筛查中，每1000名所有年龄段的男性在整个生命周期中，因前列腺癌死亡的人数减少了9人（减少28%），接受缓和治疗的人数减少了14人（减少35%），寿命增加了73年（平均每例前列腺癌死亡避免8.4年）。获得的QALYs为56（范围：- 21,97），比未调整的生命年减少23%。需要筛查的人数（NNS）为98，需要检测的人数（NND）为5。同样邀请年龄在70-74岁之间的男性，结果是寿命更长（82年），但质量寿命相似（56年）。尽管NNS和NND比先前计算的更有利，但PSA筛查的益处因QALYs的丧失而减少，QALYs主要依赖于诊断后的长期影响。在提出关于筛查的普遍建议之前，ERSPC和生活质量的长期随访数据是必不可少的。
The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% prostate cancer mortality reduction among screened men after 11 years. However, it is uncertain to what extent harms from overdiagnosis and treatment on quality of life counterbalance this benefit. Based on ERSPC follow-up data, we used micro-simulation modeling (MISCAN) to predict the number of prostate cancers, treatments, deaths and quality-adjusted life-years (QALYs) gained following the introduction of screening. Various screening strategies, efficacies, and quality of life assumptions were modeled. Per 1,000 men of all ages followed for their entire lifespan we predicted for annual screening from age 55–69 years: 9 fewer deaths due to prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and 73 life-years gained (average 8.4 years per prostate cancer death avoided). QALYs gained were 56 (range: −21, 97), a reduction of 23% from unadjusted life-years gained. The number needed to screen (NNS) was 98 and number needed to detect (NND) 5. Also inviting men aged 70–74 resulted in more life-years (82) but similar QALYs (56). Although NNS and NND are more favorable than previously calculated, the benefit of PSA screening is diminished by loss of QALYs, that is dependent primarily on post-diagnosis long-term effects. Longer follow-up data from both the ERSPC and quality of life are essential before making universal recommendations regarding screening.