哈萨克斯坦的基于人群的前列腺癌筛查

Population-based Prostate Cancer Screening in Kazakhstan.

作者信息

Ishkinin Yevgeniy, Zhylkaidarova Alma, Nurgaliyev Nurzhan, Auyezova Elmira, Oshibayeva Ainash, Gorbunova Nadezhda

机构信息

Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.

Medical University "High School of Public Health", Almaty, Kazakhstan.

出版信息

Iran J Public Health. 2017 Jul;46(7):917-922.

PMID:28845402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5563873/

Abstract

BACKGROUND

Issues of mass screening for prostate cancer rather controversial since 2013 in 11 regions of Kazakhstan introduced a population-based screening for prostate cancer, so we need to evaluate its results.

METHODS

In different regions of Kazakhstan during 2013-2015, a total of 321548 prostate-specific antigens (PSA) were determined in men aged 50-66 yr, under the Prostate Health Index (PHI) and transrectal ultrasonography (TRUS) guided prostate biopsy with histological examination.

RESULTS

PSA level up to 4 ng/ml in 310870 (96.7%) men, PSA level between 4 and 10 ng/ml in 8 624 (2.7%) men, PSA level above 10 ng/ml in 2054 (0.6%) men. PHI was identified in 5716 (1.8%) men, of which 2867 cases were with PHI ≥ 25 (35.9%). Totally, 3680 biopsies (1.1%) of the prostate were performed. As part of the screening, 2870 cases (0.88%) of benign prostatic hyperplasia and prostatic intraepithelial neoplasia were found. Of 742 cases of prostate cancer (0.23%) were revealed. The stages of prostate cancer screening were as follows: stage I in 172 men (23.2%), stage II in 444 men (59.8%), stage III in 98 men (13.2%) and stage IV in 28 (3.8%) men. The indicators of prostate cancer early diagnosis in the I-II stages were bigger in the "screening regions" than in the "traditional diagnostics" regions: RR 1.35 95% CI (1.24 - 1.46), OR 1.84 95% CI (1.58-2.15). Prostate cancer was detected at I-II stages in the "screening" regions only by screening vs traditional diagnostics, with RR 1.64 95% CI (1.56 - 1.73), OR 4.77 95% CI (3.87-5.87).

CONCLUSION

Implementation of screening can improve the diagnosis of prostate cancer in the early stages.

摘要

背景

自2013年起，哈萨克斯坦11个地区开展了基于人群的前列腺癌筛查，该筛查问题颇具争议，因此我们需要评估其结果。

方法

2013年至2015年期间，在哈萨克斯坦不同地区，对50至66岁男性共检测了321548次前列腺特异性抗原（PSA），并在前列腺健康指数（PHI）和经直肠超声（TRUS）引导下进行前列腺活检及组织学检查。

结果

310870名（96.7%）男性的PSA水平高达4 ng/ml，8624名（2.7%）男性的PSA水平在4至10 ng/ml之间，2054名（0.6%）男性的PSA水平高于10 ng/ml。5716名（1.8%）男性检测出PHI，其中2867例PHI≥25（35.9%）。共进行了3680例（1.1%）前列腺活检。作为筛查的一部分，发现2870例（0.88%）良性前列腺增生和前列腺上皮内瘤变。共发现742例前列腺癌（0.23%）。前列腺癌筛查分期如下：I期172例（23.2%），II期444例（59.8%），III期98例（13.2%），IV期28例（3.8%）。“筛查地区”前列腺癌I-II期的早期诊断指标高于“传统诊断”地区：相对危险度1.35，95%可信区间（1.24 - 1.46），比值比1.84，95%可信区间（1.58 - 2.15）。仅通过筛查在“筛查”地区I-II期检测出前列腺癌，而传统诊断未检测出，相对危险度1.64，95%可信区间（1.56 - 1.73），比值比4.77，95%可信区间（(3.87 - 5.87）。