Hippisley-Cox Julia, Coupland Carol
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Division of Primary Care, University of Nottingham, Nottingham.
Br J Gen Pract. 2021 Apr 29;71(706):e364-e371. doi: 10.3399/bjgp20X714137. Print 2021 May.
Diagnosis of prostate cancer at an early stage can potentially identify tumours when intervention may improve treatment options and survival.
To develop and validate an equation to predict absolute risk of prostate cancer in asymptomatic men with prostate specific antigen (PSA) tests in primary care.
Cohort study using data from English general practices, held in the QResearch database.
Routine data were collected from 1098 QResearch English general practices linked to mortality, hospital, and cancer records for model development. Two separate sets of practices were used for validation. In total, there were 844 455 men aged 25-84 years with PSA tests recorded who were free of prostate cancer at baseline in the derivation cohort; the validation cohorts comprised 292 084 and 316 583 men. The primary outcome was incident prostate cancer. Cox proportional hazards models were used to derive 10-year risk equations. Measures of performance were determined in both validation cohorts.
There were 40 821 incident cases of prostate cancer in the derivation cohort. The risk equation included PSA level, age, deprivation, ethnicity, smoking status, serious mental illness, diabetes, BMI, and family history of prostate cancer. The risk equation explained 70.4% (95% CI = 69.2 to 71.6) of the variation in time to diagnosis of prostate cancer () (D statistic 3.15, 95% CI = 3.06 to 3.25; Harrell's C-index 0.917, 95% CI = 0.915 to 0.919). Two-step approach had higher sensitivity than a fixed PSA threshold at identifying prostate cancer cases (identifying 68.2% versus 43.9% of cases), high-grade cancers (49.2% versus 40.3%), and deaths (67.0% versus 31.5%).
The risk equation provided valid measures of absolute risk and had higher sensitivity for incident prostate cancer, high-grade cancers, and prostate cancer mortality than a simple approach based on age and PSA threshold.
早期诊断前列腺癌有可能在干预措施可改善治疗方案和生存率时识别肿瘤。
开发并验证一个用于预测基层医疗中进行前列腺特异性抗原（PSA）检测的无症状男性患前列腺癌绝对风险的方程。
使用QResearch数据库中来自英国全科医疗的数据进行队列研究。
从1098家与死亡率、医院和癌症记录相关联的英国QResearch全科医疗中收集常规数据用于模型开发。使用两组不同的医疗机构进行验证。推导队列中共有844455名年龄在25 - 84岁且记录了PSA检测结果且基线时无前列腺癌的男性；验证队列分别包含292084名和316583名男性。主要结局是前列腺癌发病。使用Cox比例风险模型推导10年风险方程。在两个验证队列中确定性能指标。
推导队列中有40821例前列腺癌发病病例。风险方程包括PSA水平、年龄、贫困程度、种族、吸烟状况、严重精神疾病、糖尿病、体重指数和前列腺癌家族史。该风险方程解释了前列腺癌诊断时间变异的70.4%（95%可信区间 = 69.2至71.6）（D统计量3.15，95%可信区间 = 3.06至3.25；Harrell氏C指数0.917，95%可信区间 = 0.915至0.919）。在识别前列腺癌病例（分别识别出68.2%和43.9%的病例）、高级别癌症（49.2%和40.3%）以及死亡病例（67.0%和31.5%）方面，两步法比固定的PSA阈值具有更高的敏感性。
该风险方程提供了有效的绝对风险测量，并且对于前列腺癌发病、高级别癌症以及前列腺癌死亡率而言，比基于年龄和PSA阈值的简单方法具有更高的敏感性。
