调和欧洲随机前列腺癌筛查研究（ERSPC）和前列腺、肺癌、结直肠癌和卵巢癌筛查试验（PLCO）中筛查对前列腺癌死亡率的影响。
Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials.
作者信息
Tsodikov Alex, Gulati Roman, Heijnsdijk Eveline A M, Pinsky Paul F, Moss Sue M, Qiu Sheng, de Carvalho Tiago M, Hugosson Jonas, Berg Christine D, Auvinen Anssi, Andriole Gerald L, Roobol Monique J, Crawford E David, Nelen Vera, Kwiatkowski Maciej, Zappa Marco, Luján Marcos, Villers Arnauld, Feuer Eric J, de Koning Harry J, Mariotto Angela B, Etzioni Ruth
机构信息
From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France.
出版信息
Ann Intern Med. 2017 Oct 3;167(7):449-455. doi: 10.7326/M16-2586. Epub 2017 Sep 5.
BACKGROUND
The ERSPC (European Randomized Study of Screening for Prostate Cancer) found that screening reduced prostate cancer mortality, but the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial) found no reduction.
OBJECTIVE
To evaluate whether effects of screening on prostate cancer mortality relative to no screening differed between the ERSPC and PLCO.
DESIGN
Cox regression of prostate cancer death in each trial group, adjusted for age and trial. Extended analyses accounted for increased incidence due to screening and diagnostic work-up in each group via mean lead times (MLTs), which were estimated empirically and using analytic or microsimulation models.
SETTING
Randomized controlled trials in Europe and the United States.
PARTICIPANTS
Men aged 55 to 69 (ERSPC) or 55 to 74 (PLCO) years at randomization.
INTERVENTION
Prostate cancer screening.
MEASUREMENTS
Prostate cancer incidence and survival from randomization; prostate cancer incidence in the United States before screening began.
RESULTS
Estimated MLTs were similar in the ERSPC and PLCO intervention groups but were longer in the PLCO control group than the ERSPC control group. Extended analyses found no evidence that effects of screening differed between trials (P = 0.37 to 0.47 [range across MLT estimation approaches]) but strong evidence that benefit increased with MLT (P = 0.0027 to 0.0032). Screening was estimated to confer a 7% to 9% reduction in the risk for prostate cancer death per year of MLT. This translated into estimates of 25% to 31% and 27% to 32% lower risk for prostate cancer death with screening as performed in the ERSPC and PLCO intervention groups, respectively, compared with no screening.
LIMITATION
The MLT is a simple metric of screening and diagnostic work-up.
CONCLUSION
After differences in implementation and settings are accounted for, the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality.
PRIMARY FUNDING SOURCE
National Cancer Institute.
背景
欧洲前列腺癌筛查随机研究（ERSPC）发现筛查可降低前列腺癌死亡率，但前列腺、肺癌、结直肠癌和卵巢癌筛查试验（PLCO）则未发现死亡率降低。
目的
评估ERSPC和PLCO中筛查相对于未筛查对前列腺癌死亡率的影响是否存在差异。
设计
对每个试验组的前列腺癌死亡进行Cox回归分析，并根据年龄和试验进行调整。扩展分析通过平均提前期（MLT）考虑了每组因筛查和诊断检查导致的发病率增加，MLT通过经验估计以及使用分析模型或微观模拟模型进行估计。
设置
欧洲和美国的随机对照试验。
参与者
随机分组时年龄在55至69岁（ERSPC）或55至74岁（PLCO）的男性。
干预
前列腺癌筛查。
测量
随机分组后的前列腺癌发病率和生存率；美国筛查开始前的前列腺癌发病率。
结果
ERSPC和PLCO干预组的估计MLT相似，但PLCO对照组的MLT比ERSPC对照组更长。扩展分析未发现有证据表明各试验之间筛查效果存在差异（P = 0.37至0.47[MLT估计方法的范围]），但有强有力的证据表明益处随MLT增加（P = 0.0027至0.0032）。估计每年的MLT可使前列腺癌死亡风险降低7%至9%。这转化为与未筛查相比，ERSPC和PLCO干预组进行筛查时前列腺癌死亡风险分别降低25%至31%和27%至32%的估计值。
局限性
MLT是筛查和诊断检查的一个简单指标。
结论
在考虑实施和背景差异后，ERSPC和PLCO提供了相互印证的证据，表明筛查可降低前列腺癌死亡率。
主要资金来源
美国国立癌症研究所。
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