Temkin Sarah M, Miller Eric A, Samimi Goli, Berg Christine D, Pinsky Paul, Minasian Lori
Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, VA, USA.
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Eur J Cancer. 2017 Dec;87:182-188. doi: 10.1016/j.ejca.2017.10.015. Epub 2017 Nov 21.
A mortality benefit from screening for ovarian cancer has never been demonstrated. The aim of this study was to evaluate the screening outcomes for different histologic subtypes of ovarian cancers.
Women in the screening arm of the Prostate, Lung, Colorectal and Ovarian Screening Trial underwent CA-125 and transvaginal ultrasound annually for 3-5 years. We compared screening test characteristics (including overdiagnosis) and outcomes by tumour type (type II versus other) and study arm (screening versus usual care).
Of 78,215 women randomised, 496 women were diagnosed with ovarian cancer. Of the tumours that were characterised (n = 413; 83%), 74% (n = 305) were type II versus 26% other (n = 108). Among screened patients, 70% of tumours were type II compared to 78% in usual care (p = 0.09). Within the screening arm, 29% of type II tumours were screen detected compared to 54% of the others (p < 0.01). The sensitivity of screening was 65% for type II tumours versus 86% for other types (p = 0.02). 15% of type II screen-detected tumours were stage I/II, compared to 81% of other tumours (p < 0.01). The overdiagnosis rate was lower for type II compared to other tumours (28.2% versus 72.2%; p < 0.01). Ovarian cancer-specific survival was worse for type II tumours compared to others (p < 0.01). Survival was similar for type II (p = 0.74) or other types (p = 0.32) regardless of study arm.
Test characteristics of screening for ovarian cancer differed for type II tumours compared to other ovarian tumours. Type II tumours were less likely to be screen diagnosed, early stage at diagnosis or overdiagnosed.
卵巢癌筛查的死亡率获益从未得到证实。本研究的目的是评估不同组织学亚型卵巢癌的筛查结果。
参加前列腺、肺、结直肠癌和卵巢癌筛查试验筛查组的女性每年接受CA-125和经阴道超声检查，持续3至5年。我们按肿瘤类型（II型与其他类型）和研究组（筛查组与常规护理组）比较了筛查试验特征（包括过度诊断）和结果。
在随机分组的78215名女性中，496名女性被诊断为卵巢癌。在已明确特征的肿瘤中（n = 413；83%），74%（n = 305）为II型，26%为其他类型（n = 108）。在筛查患者中，70%的肿瘤为II型，而常规护理组为78%（p = 0.09）。在筛查组中，29%的II型肿瘤通过筛查发现，而其他类型为54%（p < 0.01）。II型肿瘤的筛查敏感性为65%，其他类型为86%（p = 0.02）。II型筛查发现的肿瘤中15%为I/II期，而其他肿瘤为81%（p < 0.01）。II型肿瘤的过度诊断率低于其他肿瘤（28.2%对72.2%；p < 0.01）。II型肿瘤的卵巢癌特异性生存率低于其他肿瘤（p < 0.01）。无论研究组如何，II型（p = 0.74）或其他类型（p = 0.32）的生存率相似。
与其他卵巢肿瘤相比，II型肿瘤的卵巢癌筛查试验特征有所不同。II型肿瘤被筛查诊断、诊断时处于早期或过度诊断的可能性较小。
