Lead times and overdetection due to prostate-specific antigen screening:: Estimates from the European randomized study of screening for prostate cancer
Lead times and overdetection due to prostate-specific antigen screening:: Estimates from the European randomized study of screening for prostate cancer
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DOI：
10.1093/jnci/95.12.868
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发表时间：
2003-06-18
期刊：
影响因子：
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通讯作者：
de Koning, HJ
中科院分区：
文献类型：
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作者：
Draisma, G;Boer, R;de Koning, HJ
背景资料：前列腺癌筛查可以提前诊断时间（提前期），并检测出在没有筛查的情况下无法诊断的癌症（过度检测）。这两种结果对筛查的净效益有相当大的影响。研究方法：我们根据欧洲前列腺癌筛查随机研究（ERSPC）的鹿特丹部分的结果以及基线前列腺癌发病率和分期分布数据开发了模拟模型，该研究招募了42376名男性，其中确定了1498例前列腺癌。这些模型被用来预测平均前置时间，过度检测率，和范围（相当于约95%的置信区间）与不同的筛选程序。结果：平均前置时间和过度检测率取决于男性在筛查时的年龄。对于55岁时的单次筛查试验，估计平均提前时间为12.3年（范围= 11.6-14.1年），过度检出率为27%（范围24%-37%）;在75岁时，估计分别为6.0年（范围5.8-6.3年）和56%（范围= 53%-61%）。对于年龄从55岁到67岁的筛查间隔为4年的筛查项目，估计平均提前时间为11.2年（范围= 10.8-12.1年），过度检出率为48%（范围= 44%-55%）。该筛查计划将前列腺癌诊断的终生风险从6.4%提高到10.6%，相对增加65%（范围= 56%-87%）。在55岁至67岁的年度筛查中，估计过度检出率为50%（范围= 46%-57%），终生前列腺癌风险增加80%（范围= 69%-116%）。将每年或四年一次的筛查延长到75岁，将导致每检测到一种临床相关癌症至少有两例过度检测。结论：这些基于模型的前置时间估计支持前列腺癌筛查间隔超过1年。
Background: Screening for prostate cancer advances the time of diagnosis (lead time) and detects cancers that would not have been diagnosed in the absence of screening (over-detection). Both consequences have considerable impact on the net benefits of screening. Methods: We developed simulation models based on results of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which enrolled 42376 men and in which 1498 cases of prostate cancer were identified, and on baseline prostate cancer incidence and stage distribution data. The models were used to predict mean lead times, overdetection rates, and ranges (corresponding to approximate 95% confidence intervals) associated with different screening programs. Results: Mean lead times and rates of overdetection depended on a man's age at screening. For a single screening test at age 55, the estimated mean lead time was 12.3 years (range = 11.6-14.1 years) and the overdetection rate was 27% (range 24%-37%); at age 75, the estimates were 6.0 years (range 5.8-6.3 years) and 56 % (range = 53 %-61 %), respectively. For a screening program with a 4-year screening interval from age 55 to 67, the estimated mean lead time was 11.2 years (range = 10.8-12.1 years), and the overdetection rate was 48% (range = 44%-55%). This screening program raised the lifetime risk of a prostate cancer diagnosis from 6.4% to 10.6%, a relative increase of 65% (range = 56%-87%). In annual screening from age 55 to 67, the estimated overdetection rate was 50% (range = 46%-57%) and the lifetime prostate cancer risk was increased by 80% (range = 69%-116%). Extending annual or quadrennial screening to the age of 75 would result in at least two cases of overdetection for every clinically relevant cancer detected. Conclusions: These model-based lead-time estimates support a prostate cancer screening interval of more than 1 year.