欧洲前列腺癌筛查随机研究（ERSPC）-鹿特丹研究中的间期癌

Interval carcinomas in the European Randomized Study of Screening for Prostate Cancer (ERSPC)-Rotterdam.

作者信息

van der Cruijsen-Koeter Ingrid W, van der Kwast T H, Schröder Fritz H

机构信息

Department of Urology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

出版信息

J Natl Cancer Inst. 2003 Oct 1;95(19):1462-6. doi: 10.1093/jnci/djg057.

DOI:10.1093/jnci/djg057

PMID:14519752

Abstract

BACKGROUND

The interval cancer rate is an important parameter for determining the sensitivity of a screening procedure and the screening interval. We evaluated the time and mechanism of detection and the stage distribution of interval prostate cancers diagnosed during a 4-year screening interval.

METHODS

We determined the rate of interval cancers and the sensitivity of the screening protocol (involving prostate-specific antigen, digital rectal and transrectal ultrasound examinations) in a cohort of 17 226 men (8350 on the screened arm, 8876 on the control arm) enrolled consecutively on the European Randomized Study of Screening for Prostate Cancer-Rotterdam. Men on the screened arm received a first screen between October 1993 and December 1996 and a scheduled second screen 4 years later. Prostate cancers detected in men enrolled on the control arm over the same 4-year period and, between screens, in men on the screened arm, were identified by linkage to the Dutch national cancer registry.

RESULTS

During the first screen, 412 prostate cancers were detected. During the subsequent 4-year period, 135 cancers were diagnosed in men in the control arm and 25 cancers were diagnosed in men in the screened arm. Seven of the 25 cancers were diagnosed in men who had refused a recommended biopsy at their initial screen. Of the remaining 18 cancers, all were classified as stage T1A-C or T2A and none were poorly differentiated or metastatic. The rate of interval cancers relative to the number of cancers in the control group was 18.5% (25/135), or 13.3% (18/135), if the seven who refused an initial biopsy were excluded. The sensitivity of the screening protocol was 79.8% when considering all 25 interval cancers and 85.5% when considering 18 interval cancers.

CONCLUSION

The interval cancer rate with a 4-year screening interval was low, confirming that the screening procedure has a high sensitivity and that the 4-year screening interval is reasonable.

摘要

背景

间期癌发生率是确定筛查程序敏感性和筛查间隔的重要参数。我们评估了在4年筛查间隔期间诊断出的间期前列腺癌的检测时间和机制以及分期分布。

方法

在欧洲前列腺癌筛查随机研究-鹿特丹队列中，我们确定了17226名男性（筛查组8350名，对照组8876名）中间期癌的发生率以及筛查方案（包括前列腺特异性抗原、直肠指检和经直肠超声检查）的敏感性。筛查组的男性在1993年10月至1996年12月期间接受了首次筛查，并在4年后接受了预定的第二次筛查。通过与荷兰国家癌症登记处的关联，确定了在同一4年期间对照组男性以及筛查组男性在两次筛查之间检测到的前列腺癌。

结果

在首次筛查期间，检测到412例前列腺癌。在随后的4年期间，对照组有135名男性被诊断出患有癌症，筛查组有25名男性被诊断出患有癌症。25例癌症中有7例是在初次筛查时拒绝接受推荐活检的男性中诊断出来的。在其余18例癌症中，所有病例均被分类为T1A-C期或T2A期，且均无低分化或转移情况。相对于对照组癌症数量的间期癌发生率为18.5%（25/135），如果排除7名拒绝初次活检的患者，则为13.3%（18/135）。考虑所有25例间期癌时，筛查方案的敏感性为79.8%，考虑18例间期癌时为85.5%。