Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan.
National Cancer Registry Section, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan.
Cancer Epidemiol Biomarkers Prev. 2020 Jun;29(6):1222-1228. doi: 10.1158/1055-9965.EPI-19-1228. Epub 2020 Mar 13.
This study aimed to assess long-term trends in the incidence of prostate cancer by stage at diagnosis before and after the introduction of population-based PSA screening.
We used data from three population-based cancer registries in Japan. A total of 29,458 malignant prostate cancer cases diagnosed between 1993 and 2014 were used for the analysis. Multiple imputation with chained equations was used to impute a specific stage at diagnosis for cases with "unknown" and missing status. We estimated the age-standardized incidence rates by stage at diagnosis from 1993 to 2014, and used joinpoint linear regression models to assess changes in trend.
Joinpoint analyses after imputation showed that localized cancer was stable from 1993 to 2000, followed by a pronounced but insignificant increase through 2003 (from 12.1 per 100,000 in 2001 to 34.1 per 100,000 in 2003), and a significant increase thereafter [annual percentage change (APC), 4.1%]. For regional cancer, the imputed data showed that the increasing trend lasted from 1993 to 2006 (APC, 12.5%), then leveled off through 2014. For distant prostate cancer, the imputed data showed the increasing trend continued from 1993 to 2004 (APC, 2.4%), and started to marginally decline thereafter (APC, -2.2%).
Our study confirmed a significantly rapid increase in localized prostate cancer after the spread of PSA screening in Japan, with a marginal decrease in distant prostate cancer after 2004.
Evaluation of the effectiveness of PSA screening would require a comprehensive analysis of changes in mortality, survival, and treatment practices over time.
本研究旨在评估在引入基于人群的 PSA 筛查前后，前列腺癌诊断时的分期的长期趋势。
我们使用了来自日本三个基于人群的癌症登记处的数据。共分析了 1993 年至 2014 年间诊断的 29458 例恶性前列腺癌病例。使用链式方程的多重插补法对“未知”和缺失状态的病例进行了特定分期的插补。我们根据诊断时的分期估计了 1993 年至 2014 年的年龄标准化发病率，并使用联合点线性回归模型评估了趋势变化。
插补后的联合点分析显示，局部癌在 1993 年至 2000 年保持稳定，随后在 2003 年之前出现显著但不显著的增加（从 2001 年的每 100,000 人 12.1 例增加到 2003 年的每 100,000 人 34.1 例），此后显著增加[年变化百分比（APC）为 4.1%]。对于区域性癌症，插补数据显示，从 1993 年到 2006 年，上升趋势持续（APC，12.5%），然后在 2014 年趋于平稳。对于远处前列腺癌，插补数据显示，从 1993 年到 2004 年，上升趋势持续（APC，2.4%），此后略有下降（APC，-2.2%）。
我们的研究证实，在日本 PSA 筛查广泛传播后，局部前列腺癌的发病率显著快速增加，而 2004 年后远处前列腺癌的发病率略有下降。
评估 PSA 筛查的效果需要综合分析随着时间的推移死亡率、生存率和治疗实践的变化。
