意大利不同时期按风险类别划分的前列腺癌死亡率和发病率变化：前列腺特异性抗原（PSA）普及的可能影响。

Changes in mortality and incidence of prostate cancer by risk class in different periods in Italy: the possible effects of PSA spread.

作者信息

Vicentini Massimo, Sacchettini Claudio, Trama Annalisa, Nicolai Nicola, Gatta Gemma, Botta Laura, Valdagni Riccardo, Giorgi Rossi Paolo

机构信息

Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia - Italy.

Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia - Italy.

出版信息

Tumori. 2017 May 12;103(3):292-298. doi: 10.5301/tj.5000613. Epub 2017 Feb 28.

DOI:10.5301/tj.5000613

PMID:28291906

Abstract

PURPOSE

In Italy, the spread of prostate-specific antigen (PSA) testing varies in different areas. A peak of incidence was reached in 2003-2004 in some areas, while in others the incidence is still increasing. Mortality has declined since 1999 in some areas, while it remains stable in others. We compared mortality and the risk of advanced cancer over 2 periods (1996-1998; 2005-2007) and by geographic area characterized by a different spread of PSA, to understand the possible impact of PSA on the epidemiology of prostate cancer.

METHODS

In 8 Italian Cancer Registries (CRs), 4,632 cases diagnosed over 2 periods, 1996-1998 and 2005-2007, were sampled to assess risk class. The CRs were classified into late and early phase of PSA testing depending on whether an incidence peak had been reached by 2008. Incidence by risk class was estimated based on overall incidence in each CR and on risk class distribution in the sample. We calculated standardized mortality (MRR) and risk class-specific incidence rate ratios (IRR) to compare the 2 periods.

RESULTS

Incidence increased from 1996-1998 to 2005-2007 (IRR 1.5; 95% CI 1.4, 1.6). High-risk and metastatic cancer incidence decreased only in late-phase areas (IRR 0.78; 95% CI 0.69, 0.88; and 0.40; 95% CI 0.30, 0.54, respectively), while in early-phase areas, incidence remained virtually stable (IRR 1.2; 95% CI 1.0, 1.4; and 0.77; 95% CI 0.59, 1.0, respectively). Mortality decreased only in late-phase areas (MRR 0.81; 95% CI 0.85, 0.97; vs 1.1; 95% CI 0.92, 1.2) in early-phase areas.

CONCLUSIONS

Mortality reduction and a decrease in high-risk and metastatic cases occurred simultaneously only in areas in late phase of PSA spread.

摘要

目的

在意大利，前列腺特异性抗原（PSA）检测的普及在不同地区存在差异。2003 - 2004年，部分地区发病率达到峰值，而在其他地区发病率仍在上升。自1999年以来，部分地区的死亡率有所下降，而在其他地区则保持稳定。我们比较了两个时期（1996 - 1998年；2005 - 2007年）以及不同PSA普及程度的地理区域的死亡率和晚期癌症风险，以了解PSA对前列腺癌流行病学可能产生的影响。

方法

在8个意大利癌症登记处（CRs）中，对1996 - 1998年和2005 - 2007年这两个时期诊断出的4632例病例进行抽样，以评估风险类别。根据到2008年是否达到发病率峰值，将癌症登记处分为PSA检测的晚期和早期阶段。基于每个癌症登记处的总体发病率和样本中的风险类别分布，估计各风险类别的发病率。我们计算标准化死亡率（MRR）和风险类别特异性发病率比（IRR），以比较这两个时期。

结果

从1996 - 1998年到2005 - 2007年发病率上升（IRR 1.5；95% CI 1.4, 1.6）。高危和转移性癌症发病率仅在晚期地区下降（IRR分别为0.78；95% CI 0.69, 0.88；以及0.40；95% CI 0.30, 0.54），而在早期地区，发病率基本保持稳定（IRR分别为1.2；95% CI 1.0, 1.4；以及0.77；95% CI 0.59, 1.0）。死亡率仅在晚期地区下降（MRR 0.81；95% CI 0.85, 0.97；早期地区为1.1；95% CI 0.92, 1.2）。