诊断时局部性前列腺癌的临床阶段和级别迁移在过去十年中
Edoardo Beatrici1, Dejan K Filipas2, Benjamin V Stone3
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy.
Urologic oncology
|October 18, 2023
概括
在诊断时,侵袭性前列腺癌 (PCa) 的比例显著增加,而COVID-19大流行可能加快了这一趋势. 这种转变表明,在过去十年中,晚期疾病检测的数量有所增加.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 公共卫生 公共卫生
背景情况:
- 2010年代初的数据表明,诊断更具攻击性的前列腺癌 (PCa) 的趋势.
- 2012年美国预防服务工作组 (USPSTF) 对前列腺特异性抗原 (PSA) 查的建议可能导致了这一转变.
- 2018年USPSTF建议和COVID-19大流行对医疗保健准入的影响是评估的关键因素.
研究的目的:
- 调查2018年USPSTF建议和COVID-19疫情对PCa阶段和等级迁移的影响.
- 测试COVID-19大流行进一步加剧了诊断更具侵略性的PCa.的趋势的假设.
主要方法:
- 使用国家癌症数据库分析2010年至2020年间诊断的局部PCa病例.
- 基于D'Amico风险分类和临床阶段和等级趋势分析的PCa病例分层.
- 多变量逻辑回归和边际效应分析,以评估诊断年和疾病特征之间的关联.
主要成果:
- 低风险PCa的比例从2010年的34.9%下降到2020年的17.7%.
- 观察到更高的PSA水平 (≥10 ng/dL),高级T阶段 (cT3-T4),更高的格里森等级组 (ISUP GG 3-5) 和中等/高风险分类的几率显著增加.
- 晚期疾病特征的概率在晚年达到顶峰,在2018年之后和COVID-19大流行期间观察到显著增加.
结论:
- 在诊断时,持续向更激进的PCa转变得到证实,COVID-19流行病可能发挥了重要作用.
- 2018年USPSTF建议的影响似乎是有限的,并且可能会被大流行的影响所困惑.
- 需要进一步的研究来评估在后疫情时代查建议的长期后果.
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