Dong Fei, Reuther Alwyn M, Magi-Galluzzi Cristina, Zhou Ming, Kupelian Patrick A, Klein Eric A
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Urology. 2007 Nov;70(5):839-42. doi: 10.1016/j.urology.2007.09.001.
Serum prostate specific antigen (PSA) screening has led to clinical and pathologic stage migration. We examined patients treated by radical prostatectomy between 1987 and 2005 to establish temporal trends in pathologic stage migration as assessed by the proportion of patients with nonorgan-confined disease (NOCD).
Step-sectioned prostatectomy specimens of 3364 consecutively treated patients were evaluated by year. The data were modeled by joinpoint regression, and the optimal model was selected by a Bayesian information criterion.
From 1987 to 2005, the population underwent pathologic stage migration toward more organ-confined tumors (P <0.0001). The proportion of patients with NOCD exhibited changes in trend at 1992 and 1995. After widespread implementation of PSA screening, stage migration accelerated between 1992 and 1995. Since 1995, stage migration has substantially slowed but continues at an annual change of -4.2% (P = 0.0027).
The presence of NOCD at prostatectomy has declined substantially in the PSA era. Recent slowing in this trend suggests a diminishing effect of PSA screening on pathologic stage migration.
血清前列腺特异性抗原（PSA）筛查导致了临床和病理分期的迁移。我们研究了1987年至2005年间接受根治性前列腺切除术的患者，以确定通过非器官局限性疾病（NOCD）患者比例评估的病理分期迁移的时间趋势。
对3364例连续接受治疗患者的前列腺切除标本进行逐年评估。数据采用连接点回归建模，并通过贝叶斯信息准则选择最优模型。
1987年至2005年，患者群体的病理分期向更多器官局限性肿瘤迁移（P<0.0001）。NOCD患者比例在1992年和1995年出现趋势变化。PSA筛查广泛应用后，1992年至1995年分期迁移加速。自1995年以来，分期迁移大幅放缓，但仍以每年-4.2%的速度持续变化（P=0.0027）。
在PSA时代，前列腺切除术中NOCD的发生率大幅下降。近期这一趋势的放缓表明PSA筛查对病理分期迁移的影响在减弱。
