Overall and Multiphasic Findings of the Prostate, Lung, Colorectal and Ovarian (PLCO) Randomized Cancer Screening Trial.
Overall and Multiphasic Findings of the Prostate, Lung, Colorectal and Ovarian (PLCO) Randomized Cancer Screening Trial.
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DOI：
10.2174/1574887113666180409153059
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发表时间：
2018-10
影响因子：
1.9
通讯作者：
P. Prorok;Patrick Wright;T. Riley;B. Kramer;C. Berg;J. Gohagan
中科院分区：
文献类型：
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作者：
P. Prorok;Patrick Wright;T. Riley;B. Kramer;C. Berg;J. Gohagan
筛查测试通常针对单一疾病进行评估，但在实践中针对多种疾病进行多项测试。前列腺、肺、结直肠和卵巢（PLCO）癌症筛查试验同时评估了四种癌症的检测，可以被视为多阶段癌症干预。本文介绍了本试验的总体和多阶段结果。PLCO试验是一项在美国10个筛选中心进行的随机多中心试验。参与者为76，682名男性和78，215名女性，年龄在55 - 74岁之间，在试验开始时没有目标癌症。筛查测试包括前列腺癌的PSA和直肠指检、肺癌的胸部X线检查、结直肠癌的乙状结肠镜检查、卵巢癌的CA 125和经阴道超声检查。评估筛查的结果和危害，包括依从性、检测结果、发病率、死亡率、假阳性和过度诊断。结果筛查依从性为82%，906,064次检查中有72,820次（8%）为阳性，总PPV为4.2%，癌症检出率为3.38/1000。仅观察到结直肠癌的死亡率降低（RR 0.72，95% CI 0.61 - 0.85），对全因死亡率无影响。96%的阳性检查是假阳性，这表明前列腺癌和可能的卵巢癌被过度诊断。多相测试导致7374名男性和2748名女性经历了多种类型测试的多个假阳性结果。结论：多相癌症筛查导致一种靶癌症死亡率降低，并给医疗保健系统带来负担，包括大量的假阳性和可能的过度诊断。
BACKGROUND Screening tests are typically evaluated for a single disease, but multiple tests for multiple diseases are performed in practice. The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial assessed testing for four cancers simultaneously and can be viewed as a multiphasic cancer intervention. This paper presents overall and multiphasic findings of this trial. METHODS The PLCO trial was a randomized multi-center trial conducted at ten screening centers in the US. Participants were 76,682 men and 78,215 women ages 55 - 74 and free of the target cancers at trial entry. Screening tests were PSA and digital rectal examination for prostate cancer, chest x-ray for lung cancer, flexible sigmoidoscopy for colorectal cancer, CA125 and transvaginal ultrasound for ovarian cancer. Outcomes and harms of screening were assessed including compliance, test results, incidence, mortality, false positives and overdiagnosis. RESULTS Screening compliance was 82%, 72,820 (8%) of 906,064 exams were positive, the overall PPV was 4.2% and the cancer detection rate was 3.38/1000. A mortality reduction was observed only for colorectal cancer (RR 0.72, 95% CI 0.61 - 0.85) with no effect on all-cause mortality. Ninety-six percent of positive exams were falsely positive and there was a suggestion of overdiagnosis of prostate and possibly ovarian cancers. Multiphasic testing resulted in 7374 men and 2748 women experiencing multiple false positive results from multiple types of tests. CONCLUSION Multiphasic cancer screening led to reduced mortality for one target cancer and imposed a burden on the health care system that included substantial false positives and likely overdiagnosis.