Overdiagnosis and overtreatment of prostate cancer.
Overdiagnosis and overtreatment of prostate cancer.
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DOI：
10.1016/j.eururo.2013.12.062
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发表时间：
2014-06
期刊：
影响因子：
23.4
通讯作者：
Etzioni, Ruth
中科院分区：
文献类型：
--
作者：
Loeb, Stacy;Bjurlin, Marc A.;Nicholson, Joseph;Tammela, Teuvo L.;Penson, David F.;Carter, H. Ballentine;Carroll, Peter;Etzioni, Ruth
虽然前列腺癌（PCa）筛查降低了晚期疾病的发生率和死亡率，但权衡因素包括过度诊断和过度治疗。回顾PCa过度诊断和过度治疗的主要数据。电子检索科克伦对照试验中心注册中心、PubMed和Embase，从开始到2013年7月检索关于PCa过度诊断和过度治疗的原始文章。通过手动检索识别补充文献。提前时间和过度发病率方法是流行病学研究中估计过度诊断的主要方法，其估计值差异很大。随着随访的增加，需要诊断以挽救生命的PCa病例的估计数量从48例下降到5例。在临床研究中，根据根治性直肠癌切除术中低级别微小肿瘤的频率（1.7-46.8%），过度诊断率通常较低。尸检研究报告PCa在18.5- 38.5%，虽然不是所有都是低级别或低容量。影响过度诊断的因素包括研究人群、筛查方案和背景发病率，限制了不同环境之间的普遍性。文献中报告的过度治疗率差异很大，尽管当代国际研究表明越来越多地使用保守治疗。流行病学，临床和尸检研究已被用于检查PCa过度诊断，估计范围从1.7%到67%。相应地，对过度治疗的估计因患者特征而异，在国际上可能正在下降。仔细选择患者进行筛查和减少过度治疗对于保护前列腺特异性抗原检测的益处并减少下游危害非常重要。由于所有这些估计都是非常具体的人口和背景，因此在使用这些数据为政策提供信息时必须考虑到这一点。筛查减少了前列腺癌（PCa）的扩散和死亡，但过度诊断了一些可能不会造成伤害的低风险肿瘤。由于治疗具有潜在的副作用，因此并非所有PCa患者都接受积极治疗至关重要。
Although prostate cancer (PCa) screening reduces the incidence of advanced disease and mortality, trade-offs include overdiagnosis and resultant overtreatment. To review primary data on PCa overdiagnosis and overtreatment. Electronic searches were conducted in Cochrane Central Register of Controlled Trials, PubMed, and Embase from inception to July 2013 for original articles on PCa overdiagnosis and overtreatment. Supplemental articles were identified through hand searches. The lead-time and excess-incidence approaches are the main ways used to estimate overdiagnosis in epidemiological studies, with estimates varying widely. The estimated number of PCa cases needed to be diagnosed to save a life has ranged from 48 down to 5 with increasing follow-up. In clinical studies, generally lower rates of overdiagnosis have been reported based on the frequency of low-grade minimal tumors at radical prostatectomy (1.7–46.8%). Autopsy studies have reported PCa in 18.5–38.5%, although not all are low grade or low volume. Factors influencing overdiagnosis include the study population, screening protocol, and background incidence, limiting generalizability between settings. Reported rates of overtreatment vary widely in the literature, although contemporary international studies suggest increasing use of conservative management. Epidemiological, clinical, and autopsy studies have been used to examine PCa overdiagnosis, with estimates ranging widely from 1.7% to 67%. Correspondingly, estimates of overtreatment vary widely based on patient features and may be declining internationally. Careful patient selection for screening and reducing overtreatment are important to preserve the benefits and reduce the downstream harms of prostate-specific antigen testing. Because all of these estimates are extremely population and context specific, this must be considered when using these data to inform policy. Screening reduces spread and death from prostate cancer (PCa) but overdiagnoses some low-risk tumors that may not have caused harm. Because treatment has potential side effects, it is critical that not all patients with PCa receive aggressive treatment.
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影响因子：
8.8
作者：
Heijnsdijk, E. A. M.;der Kinderen, A.;Wever, E. M.;Draisma, G.;Roobol, M. J.;de Koning, H. J.
通讯作者：
de Koning, H. J.
影响因子：
39.2
作者：
Gulati R;Gore JL;Etzioni R
通讯作者：
Etzioni R
影响因子：
6.6
作者：
Graif, Theresa;Loeb, Stacy;Catalona, William J.
通讯作者：
Catalona, William J.
影响因子：
2.1
作者：
Davidov, O;Zelen, M
通讯作者：
Zelen, M
影响因子：
6.2
作者：
Daskivich, Timothy J.;Chamie, Karim;Litwin, Mark S.
通讯作者：
Litwin, Mark S.