Prostate Cancer Mortality Reduction by Prostate-Specific Antigen-Based Screening Adjusted for Nonattendance and Contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC)
Prostate Cancer Mortality Reduction by Prostate-Specific Antigen-Based Screening Adjusted for Nonattendance and Contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC)
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DOI：
10.1016/j.eururo.2009.07.018
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发表时间：
2009-10-01
期刊：
影响因子：
23.4
通讯作者：
Auvinen, Anssi
中科院分区：
文献类型：
--
作者：
Roobol, Monique J.;Kerkhof, Melissa;Auvinen, Anssi
背景资料：在一项随机试验（欧洲前列腺癌随机筛查研究[ERSPC]）的意向筛查（ITS）分析中，基于前列腺特异性抗原（PSA）的前列腺癌（PCa）筛查显示可将前列腺特异性死亡率降低20%。这种影响可能被随机分配到筛查组的男性的缺席和随机分配到对照组的男性的污染所稀释。目的：评估调整缺席和污染后PCA特异性死亡率降低的幅度。设计、设置和参与者：我们分析了在ERSPC的7个参与中心随机分配的162243名55-69岁男性中，平均随访9年期间PCa死亡的发生率。中心还根据随机化的类型进行分组（即，之前或之后知情的书面同意）。干预：不出席被定义为不参加ERSPC的初始筛选轮。污染的估计是基于PSA在鹿特丹ERSPC控制中的使用。测量：ITS分析与调整了未出勤和污染的分析之间的相对风险（RR）和95%置信区间（CI）进行了比较，使用为此目的开发的统计方法。结果和局限性：在ITS分析中，分配到干预组的男性PCa死亡相对于对照组的RR为0.80（95% CI，0.68-0.96）。对缺课进行调整后，RR为0.73（95%CI，0.58-0.93），使用两种不同的估计值对污染进行额外调整后，估计分别减少0.69（95%CI，0.51-0.92）至0.71（95%CI，0.55-0.93）。通过单中心数据外推获得污染数据。各组centers.Conclusions之间没有发现异质性：PSA筛查可降低前列腺癌死亡的风险高达31%的男性实际筛选。这种益处应与PCa筛查中固有的过度诊断和过度治疗的程度相权衡。(C)2009年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Prostate-specific antigen (PSA) based screening for prostate cancer (PCa) has been shown to reduce prostate specific mortality by 20% in an intention to screen (ITS) analysis in a randomised trial (European Randomised Study of Screening for Prostate Cancer [ERSPC]). This effect may be diluted by nonattendance in men randomised to the screening arm and contamination in men randomised to the control arm.Objective: To assess the magnitude of the PCa-specific mortality reduction after adjustment for nonattendance and contamination.Design, setting, and participants: We analysed the occurrence of PCa deaths during an average follow-up of 9 yr in 162 243 men 55-69 yr of age randomised in seven participating centres of the ERSPC. Centres were also grouped according to the type of randomisation (ie, before or after informed written consent).Intervention: Nonattendance was defined as nonattending the initial screening round in ERSPC. The estimate of contamination was based on PSA use in controls in ERSPC Rotterdam.Measurements: Relative risks (RRs) with 95% confidence intervals (CIs) were compared between an ITS analysis and analyses adjusting for nonattendance and contamination using a statistical method developed for this purpose.Results and limitations: In the ITS analysis, the RR of PCa death in men allocated to the intervention arm relative to the control arm was 0.80 (95% CI, 0.68-0.96). Adjustment for nonattendance resulted in a RR of 0.73 (95% CI, 0.58-0.93), and additional adjustment for contamination using two different estimates led to estimated reductions of 0.69 (95% CI, 0.51-0.92) to 0.71 (95% CI, 0.55-0.93), respectively. Contamination data were obtained through extrapolation of single-centre data. No heterogeneity was found between the groups of centres.Conclusions: PSA screening reduces the risk of dying of PCa by up to 31% in men actually screened. This benefit should be weighed against a degree of over diagnosis and overtreatment inherent in PCa screening. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.