Comorbidity and Mortality Results From a Randomized Prostate Cancer Screening Trial
Comorbidity and Mortality Results From a Randomized Prostate Cancer Screening Trial
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DOI：
10.1200/jco.2010.30.5979
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发表时间：
2011-02-01
影响因子：
45.3
通讯作者：
D'Amico, Anthony V.
中科院分区：
文献类型：
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作者：
Crawford, E. David;Grubb, Robert, III;D'Amico, Anthony V.
目的前列腺癌特异性死亡率(PCSM)的估计在随机分配到干预组的男性中与在前列腺癌、肺、结肠和卵巢PC筛查研究中的常规护理相比相似。在1993-2001年间，76,693名男性被随机分配到10个美国中心的常规护理或干预中，其中73,378人(96%)在随机分配之前完成了关于合并疾病和前列腺特异性抗原(PSA)检测的问卷调查。FINE和Gray‘s多变量分析用于评估随机筛查是否与无或仅有至少一种显著共病的男性PCSM的风险相关，并调整年龄和随机前PSA测试。结果经过10年的随访，发生了9,565例死亡，其中164例死于PC。与常规护理相比，随机分配到干预组的男性没有或仅有最低程度的共病，PCSM的风险显著降低(22对38人死亡；调整后的风险比[AHR]，0.56；95%CI，0.33对0.95；P=0.03)，为防止一名PC患者在10年内死亡而需要额外治疗的人数为5人。在至少有一种显著合并症的男性中，随机分配到干预组与常规护理组相比，PCSM的风险没有降低(62对42例死亡；AHR，1.43；95%CI，0.96至2.11；P=0.08)。结论对健康状况良好的男性进行选择性PSA筛查似乎在最小限度过度治疗的情况下降低了PCSM的风险。J Clin Oncol29：355-361.(C)2010年美国临床肿瘤学会
PurposeEstimates of prostate cancer-specific mortality (PCSM) were similar for men randomly assigned to intervention compared with usual care on the Prostate, Lung, Colorectal and Ovarian PC screening study. However, results analyzed by comorbidity strata remain unknown.Patients and MethodsBetween 1993 and 2001, of 76,693 men who were randomly assigned to usual care or intervention at 10 US centers, 73,378 (96%) completed a questionnaire that inquired about comorbidity and prostate-specific antigen (PSA) testing before random assignment. Fine and Gray's multivariable analysis was performed to assess whether the randomized screening arm was associated with the risk of PCSM in men with no or minimal versus at least one significant comorbidity, adjusting for age and prerandomization PSA testing.ResultsAfter 10 years of follow-up, 9,565 deaths occurred, 164 from PC. A significant decrease in the risk of PCSM ( 22 v 38 deaths; adjusted hazard ratio [AHR], 0.56; 95% CI, 0.33 to 0.95; P = .03) was observed in men with no or minimal comorbidity randomly assigned to intervention versus usual care, and the additional number needed to treat to prevent one PC death at 10 years was five. Among men with at least one significant comorbidity, those randomly assigned to intervention versus usual care did not have a decreased risk of PCSM ( 62 v 42 deaths; AHR, 1.43; 95% CI, 0.96 to 2.11; P = .08).ConclusionSelective use of PSA screening for men in good health appears to reduce the risk of PCSM with minimal overtreatment. J Clin Oncol 29: 355-361. (c) 2010 by American Society of Clinical Oncology