Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons
Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons
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DOI：
10.1046/j.1464-410x.2002.2822.x
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发表时间：
2002-07-01
影响因子：
4.5
通讯作者：
Babb, P
中科院分区：
文献类型：
--
作者：
Quinn, M;Babb, P
研究了前列腺癌发病率、生存率、患病率和死亡率的国际模式和趋势。世界各地不同国家男性的年龄标准化发病率和死亡率来自不同来源，生存率来自欧洲和其他地方，患病率估计来自 EUROPRVAL 研究。总结了许多已发表研究的结果。前列腺癌的发病率在世界各地差异很大，迄今为止美国和加拿大的发病率最高。自 20 世纪 60 年代以来，在许多国家和大多数大陆，前列腺癌的发病率逐渐增加；美国在 20 世纪 80 年代末和 90 年代初出现了大幅增长，但在发病率相对较低的国家也出现了增长，例如：印度。 20 世纪 70 年代和 80 年代，前列腺癌的生存率有所提高； 20世纪90年代的进一步增加可能主要是早期诊断的结果。欧洲各地的生存率存在很大差异，英国的生存率远低于平均水平，但所有欧洲的生存率都远低于美国。欧洲前列腺癌的患病率存在很大差异；在一些发病率高、预期寿命高的国家，前列腺癌约占男性所有流行癌症的 15%。在许多国家，前列腺癌死亡率也有所增加，但增幅低于发病率；这与观察到的生存趋势一致。 20 世纪 90 年代中后期，包括美国、加拿大、英国、法国和奥地利在内的一些国家的死亡率略有下降。前列腺癌发病率明显增加的部分原因与诊断假象有关（特别是通过增加经尿道切除术的使用来检测临床前肿瘤），这也可能通过错误地将前列腺癌归为根本死因而对死亡证明产生影响。然而，对前列腺癌新病例登记的最大影响是 20 世纪 90 年代初至中期前列腺特异性抗原检测的可用性增加。除了归因偏差的影响之外，前列腺癌的早期诊断可能也导致了最近死亡率的略有下降。然而，鉴于该疾病从发病到死亡的缓慢发展，这不太可能是减少的主要原因。疾病管理的改变可能更为重要。有许多强有力的论据反对引入基于人群的前列腺癌筛查。
The international patterns and trends in prostate cancer incidence, survival, prevalence and mortality were examined. Age-standardized incidence and death rates among men in a variety of countries worldwide were obtained from various sources, survival rates from European sources and elsewhere, and prevalence estimates from the EUROPREVAL study. Results from many published studies were summarized. The incidence of prostate cancer varies widely around the world, with by far the highest rates in the USA and Canada. There has been a gradual increase in the incidence of prostate cancer since the 1960s in many countries and in most continents; there were large increases in the late 1980s and early 1990s in the USA, but increases have also occurred in countries with comparatively low incidence, e.g. India. Survival from prostate cancer improved during the 1970s and 1980s; further increases in the 1990s may be largely a result of earlier diagnosis. There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA. There was wide variation in the prevalence of prostate cancer in Europe; in some countries with high incidence and high life-expectancy, prostate cancers formed approximate to 15% of all prevalent cancers in men. Mortality from prostate cancer has also increased in many countries, but to a lesser extent than incidence; this is consistent with the observed trends in survival. Mortality decreased slightly in the mid to late 1990s in several countries, including the USA, Canada, England, France and Austria. Part of the apparent increases in the incidence of prostate cancer has been associated with diagnostic artefacts (particularly detecting preclinical tumours through the increased use of transurethral resection) which may also have had an effect on death certification through the incorrect attribution of prostate cancer as the underlying cause of death. However, the greatest effect on the registration of new cases of prostate cancer has been the increased availability of prostate specific antigen testing during the early- to mid-1990s. Possibly, in addition to the effect of attribution bias, the earlier diagnosis of prostate cancers has contributed to the recent slight decreases in mortality. However, this is unlikely to account for much of the reduction, given the slow development of the disease from onset to death. Changes in disease management are probably more important. There are many strong arguments against introducing population-based screening for prostate cancer.