Quaglia A, Vercelli M, Puppo A, Casella C, Artioli E, Crocetti E, Falcini F, Ramazzotti V, Tagliabue G
National Cancer Research Institute, Cancer Registry Unit, Largo Rosanna Benzi, n 10, 16132 Genova, Italy.
Eur J Cancer Prev. 2003 Apr;12(2):145-52. doi: 10.1097/00008469-200304000-00008.
The aim of the study was to investigate the variations in prostate cancer prognosis during a period of major diagnostic change, such as the introduction of the prostate-specific antigen (PSA) test. Data were provided by 14 Italian cancer registries (CRs). Incidence and follow-up information was collected for patients diagnosed from 1978 to 1994. Relative survival was computed taking into account incidence period, age, tumour stage and grade at diagnosis. A multivariate analysis was carried out to evaluate the independent simultaneous effect on survival of some prognostic determinants. A large geographical variability was observed: in 1993-1994 Italian survival rates ranged from 76% to 52%, with a north-south gradient. A striking prognostic improvement (up to +27 percentage points) between the late 1980s and the early 1990s occurred in almost all CRs, particularly with regard to younger patients. Multivariate analysis showed a strong influence of incidence period on survival, also after correction by tumour stage. The slowdown of metastatic cancers suggests that the survival improvement could be due both to the introduction of an effective opportunistic screening and to a quantitative change in the application of clinical treatment, even if the effect of the lead-time bias phenomenon has to be taken into account.
本研究的目的是调查在重大诊断变革时期（如引入前列腺特异性抗原（PSA）检测）前列腺癌预后的变化情况。数据由14个意大利癌症登记处（CRs）提供。收集了1978年至1994年确诊患者的发病率和随访信息。计算相对生存率时考虑了发病时期、年龄、诊断时的肿瘤分期和分级。进行了多变量分析，以评估一些预后决定因素对生存的独立同时效应。观察到很大的地理差异：1993 - 1994年意大利的生存率在76%至52%之间，呈南北梯度。在20世纪80年代末至90年代初，几乎所有癌症登记处都出现了显著的预后改善（高达27个百分点），尤其是对于年轻患者。多变量分析表明，即使在经肿瘤分期校正后，发病时期对生存仍有强烈影响。转移性癌症增速放缓表明，生存改善可能既归因于有效的机会性筛查的引入，也归因于临床治疗应用的定量变化，尽管必须考虑提前期偏倚现象的影响。
