前列腺特异性抗原筛查对生活质量的影响。
Quality-of-life effects of prostate-specific antigen screening.
机构信息
Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
出版信息
N Engl J Med. 2012 Aug 16;367(7):595-605. doi: 10.1056/NEJMoa1201637.
BACKGROUND
After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain.
METHODS
On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled.
RESULTS
Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life-years gained (average, 8.4 years per prostate-cancer death avoided). The number of QALYs that were gained was 56 (range, -21 to 97), a reduction of 23% from unadjusted life-years gained. To prevent one prostate-cancer death, 98 men would need to be screened and 5 cancers would need to be detected. Screening of all men between the ages of 55 and 74 would result in more life-years gained (82) but the same number of QALYs (56).
CONCLUSIONS
The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made. (Funded by the Netherlands Organization for Health Research and Development and others.).
背景
经过 11 年的随访，欧洲前列腺癌筛查随机研究（ERSPC）报告称，接受前列腺特异性抗原（PSA）水平筛查的男性前列腺癌死亡率降低了 29%。然而，由于过度诊断和治疗而导致的生活质量损害在多大程度上抵消了这一益处尚不确定。
方法
根据 ERSPC 的随访数据，我们使用微模拟筛查分析（MISCAN）来预测引入 PSA 筛查后前列腺癌数量、治疗、死亡和质量调整生命年（QALYs）的增加。对各种筛查策略、疗效和生活质量假设进行了建模。
结果
在所有年龄的 1000 名男性中，我们预测对 55 至 69 岁男性进行年度筛查，将导致前列腺癌死亡人数减少 9 人（减少 28%），接受姑息治疗的男性减少 14 人（减少 35%），总寿命延长 73 年（平均每避免一例前列腺癌死亡增加 8.4 年）。获得的 QALYs 数量为 56 个（范围为-21 至 97），比未经调整的寿命增加减少了 23%。为了预防一例前列腺癌死亡，需要筛查 98 名男性，需要检测 5 例癌症。对所有 55 至 74 岁的男性进行筛查将获得更多的寿命年（82 年），但 QALYs 数量相同（56 个）。
结论
由于诊断后长期影响，PSA 筛查的益处因 QALYs 的丧失而减少。在做出关于筛查的普遍建议之前，ERSPC 和生活质量分析的更长随访数据是必不可少的。（由荷兰健康研究与发展组织等资助）。
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