探索积极监测计划和前列腺癌死亡率之间的关系
Zhenwei Yang1,2, Eveline A M Heijnsdijk3, Lisa F Newcomb4
1Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands.
Cancer medicine
|March 16, 2024
概括
积极监测前列腺癌需要优化活检时间表. 检测癌症进展的较长延迟与前列腺癌死亡率的增加有关,这凸显了及时活检的重要性.
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
- 医疗保健服务研究 医疗服务研究
背景情况:
- 积极监测 (AS) 将前列腺癌治疗推迟到活检检测到进展,旨在减少过度治疗.
- 在AS协议中,关于最佳活检频率存在缺乏共识.
- 以前的研究假设延迟进展检测和前列腺癌死亡率之间存在联系,但缺乏经验数据.
研究的目的:
- 在积极监测期间检测前列腺癌进展的延迟与前列腺癌死亡率之间的关系.
- 解决关于活检时间表对前列腺癌管理的长期结果的影响的知识差距.
主要方法:
- 微模拟选分析 (MISCAN) 模型被调整为模拟AS程序,包括活检敏感度.
- 通过使用加拿大前列腺癌活跃监测研究 (PASS) 的数据校准了活检灵敏度.
- 模拟了四个AS计划 (每三年一次,每两年一次,每年一次,每年一次),Cox模型分析了检测延迟与死亡率的关系.
主要成果:
- 模拟活检检测进展的灵敏度为50%.
- 在更长的检测延迟和增加前列腺癌死亡风险之间发现了显著的积极关联.
- 延迟2年与前列腺癌死亡后进展的5年风险2.46%-2.69%和10年风险5.75%-5.91%相关.
- 延迟4年导致5年风险增加约8%,10年风险增加约25%.
结论:
- 积极监测中的检测延迟是前列腺癌死亡率的验证代孕标志物.
- 该研究无法确定积极监控协议中检测延迟的最终"安全"门.
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