Lai Tiffany, Kessel Bruce, Ahn Hyeong Jun, Terada Keith Y
Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Biostatistics Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
J Gynecol Oncol. 2016 Jul;27(4):e41. doi: 10.3802/jgo.2016.27.e41. Epub 2016 Apr 6.
To determine whether annual screening reduces ovarian cancer mortality in women with a family history of breast or ovarian cancer.
Data was obtained from the Prostate, Lung, Colorectal, and Ovarian cancer trial, a randomized multi-center trial conducted to determine if screening could reduce mortality in these cancers. The trial enrolled 78,216 women, randomized into either a screening arm with annual serum cancer antigen 125 and pelvic ultrasounds, or usual care arm. This study identified a subgroup that reported a first degree relative with breast or ovarian cancer. Analysis was performed to compare overall mortality and disease specific mortality in the screening versus usual care arm. In patients diagnosed with ovarian cancer, stage distribution, and survival were analyzed as a secondary endpoint.
There was no significant difference in overall mortality or disease specific mortality between the two arms. Ovarian cancer was diagnosed in 48 patients in the screening arm and 44 patients in the usual care arm. Screened patients were more likely to be diagnosed at an earlier stage than usual care patients. Patients in the screening arm diagnosed with ovarian cancer experienced a significantly improved survival compared to patients in the usual care arm; relative risk 0.66 (95% CI, 0.47 to 0.93).
Screening did not appear to decrease ovarian cancer mortality in participants with a family history of breast or ovarian cancer. Secondary endpoints, however, showed notable differences. Significantly fewer patients were diagnosed with advanced stage disease in the screening arm; and survival was significantly improved. Further investigation is warranted to assess screening efficacy in women at increased risk.
确定年度筛查是否能降低有乳腺癌或卵巢癌家族史女性的卵巢癌死亡率。
数据来自前列腺、肺、结直肠癌和卵巢癌试验，这是一项多中心随机试验，旨在确定筛查是否能降低这些癌症的死亡率。该试验招募了78216名女性，随机分为接受年度血清癌抗原125检测和盆腔超声检查的筛查组或常规护理组。本研究确定了一个报告有乳腺癌或卵巢癌一级亲属的亚组。进行分析以比较筛查组和常规护理组的总死亡率和疾病特异性死亡率。对于诊断为卵巢癌的患者，将分期分布和生存率作为次要终点进行分析。
两组之间的总死亡率或疾病特异性死亡率没有显著差异。筛查组有48例患者被诊断为卵巢癌，常规护理组有44例。与常规护理组患者相比，接受筛查的患者更有可能在早期被诊断出来。与常规护理组患者相比，筛查组中被诊断为卵巢癌的患者生存率显著提高；相对风险为0.66（95%可信区间，0.47至0.93）。
对于有乳腺癌或卵巢癌家族史的参与者，筛查似乎并未降低卵巢癌死亡率。然而，次要终点显示出显著差异。筛查组中被诊断为晚期疾病的患者明显减少；生存率显著提高。有必要进行进一步研究以评估高危女性的筛查效果。
