Increasing use of radical prostatectomy for nonlethal prostate cancer in Sweden.
Increasing use of radical prostatectomy for nonlethal prostate cancer in Sweden.
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DOI：
10.1158/1078-0432.ccr-12-1537
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发表时间：
2012-12-15
期刊：
影响因子：
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通讯作者：
Adami HO
中科院分区：
文献类型：
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作者：
Etzioni R;Mucci L;Chen S;Johansson JE;Fall K;Adami HO
在瑞典，接受根治性前列腺切除术治疗局限性前列腺癌的患者数量呈指数增长。这种增加在多大程度上反映了通过 PSA 筛查检测到的非致命性疾病的治疗情况尚不清楚。我们对 1988 年至 2008 年在瑞典接受根治性前列腺切除术的所有 18,837 名前列腺癌患者进行了一项全国性研究，并在 2009 年进行了完整随访。我们比较了累积发病率曲线、拟合 Cox 回归和治愈模型，并进行了模拟研究，以确定非致命性癌症治疗的变化、癌症特异性生存随时间的变化以及 PSA 筛查带来的前置时间的影响。研究期间，每年接受根治性前列腺切除术的数量增加了 25 倍。五年癌症特异性死亡率从 1988 年至 1992 年间诊断的患者中的 3.9%（95% CI 2.5 至 5.3）下降至 1998 至 2002 年间诊断的患者中的 0.7%（95% CI 0.4–1.1）（趋势 p < 0.001）。根据治愈模型，未治愈的风险每年下降 13%（95% CI 12-14%）。模拟研究表明，疾病特异性生存率的改善只有大约一半可以归因于交付时间。瑞典根治性前列腺切除术急剧增加中，被过度诊断的非致命性前列腺癌患者似乎占了很大一部分，而且还在不断增长，但生存率的提高也可能是由于随着时间的推移，疾病特异性死亡风险的真正降低。由于过度治疗造成的伤害和成本可能相当大，因此迫切需要确定可能从根治性前列腺切除术中受益的男性。
The number of patients in Sweden treated with radical prostatectomy for localized prostate cancer has increased exponentially. The extent to which this increase reflects treatment of non-lethal disease detected through PSA screening is unknown. We undertook a nationwide study of all 18,837 prostate cancer patients treated with radical prostatectomy in Sweden from 1988 to 2008 with complete follow-up through 2009. We compared cumulative incidence curves, fit Cox regression and cure models and performed a simulation study to determine changes in treatment of non-lethal cancer, in cancer-specific survival over time, and effect of lead-time due to PSA screening. The annual number of radical prostatectomies increased 25-fold during the study period. The five-year cancer-specific mortality decreased from 3.9% (95% CI 2.5 to 5.3) among patients diagnosed between 1988 and 1992 to 0.7% (95% CI 0.4–1.1) among those diagnosed between 1998 and 2002 (p for trend < 0.001). According to the cure model, the risk of not being cured declined by 13% (95% CI 12–14%) with each calendar year. The simulation study indicated that only about half of the improvement in disease-specific survival could be accounted for by lead-time. Patients overdiagnosed with non-lethal prostate cancer appear to account for a substantial and growing part of the dramatic increase in radical prostatectomies in Sweden but increasing survival rates are likely also due to true reductions in the risk of disease-specific death over time. Because the magnitude of harm and costs due to overtreatment can be considerable, identification of men who likely benefit from radical prostatectomy is urgently needed.