前列腺特异性抗原查和前列腺癌死亡率:美国医疗保险中针对性试验的模拟
Xabier García-Albéniz1,2, John Hsu3,4,5, Ruth Etzioni6
1CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA.
JCO clinical cancer informatics
|August 19, 2024
概括
每年进行前列腺特异性抗原 (PSA) 查可能会降低67-74岁的老年男性前列腺癌 (PC) 死亡率. 然而,查也增加了治疗并发症,对非常年长的男性来说,益处不那么明显.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 公共卫生 公共卫生
- 老年医学 老年医学
背景情况:
- 临床指南缺乏关于前列腺特异性抗原 (PSA) 查有效性的共识,特别是在老年人中.
- 之前对PSA查的随机试验已经显示出由于坚持差异的不同结果.
- 新的大规模随机试验不太可能进行.
研究的目的:
- 估计每年PSA查对67-84岁的医疗保险受益人前列腺癌 (PC) 死亡率的影响.
- 分析PC发病率和与PSA查相关的治疗并发症.
主要方法:
- 使用美国医疗保险数据 (2001-2008) 进行的大规模,基于人口的观察性研究.
- 包括537,599名67-84岁的受益人,预期寿命良好,没有先前的PC,并且在前两年没有PSA测试.
- 在8年期间,每年PSA查和没有查组之间的结果进行比较.
主要成果:
- 在67-74岁的男性中,每年PSA查与8年内每1000名男性中PC死亡人数减少约2.3人 (95% CI, -4.1至 -1.1).
- 与非查组相比,PSA查组的治疗并发症更为频繁.
- 对于75-84岁的男性,PC死亡率的估计风险差异接近于零.
结论:
- 在67-74岁的男性中,每年进行8年的PSA查似乎与降低前列腺癌死亡率相兼容,可能防止每1000名查男性中有1-4例死亡.
- 治疗并发症的频率增加是PSA查的一个考虑因素.
- 由于研究的观察性质,存在残留混的可能性.
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