评估年龄对前列腺癌过度诊断的影响,使用随机试验的长期随访
medRxiv : the preprint server for health sciences
|February 6, 2026
概括
前列腺癌过度诊断,癌症的检测不太可能影响一个男人.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 生物统计学 生物统计学
背景情况:
- 前列腺癌过度诊断,定义为检测患者一生中不会在临床上表现出来的癌症,造成了严重的公共卫生问题.
- 过度诊断影响生活质量和医疗保健资源分配,需要准确估计其患病率和影响因素.
- 前列腺特异性抗原 (PSA) 检测是前列腺癌检测的主要驱动力,但也导致过度诊断.
研究的目的:
- 用竞争风险方法来估计患者年龄对15年内前列腺癌过度发病率的影响,称为过度诊断.
- 分析前列腺癌 (CAP) 随机试验和英语男性竞争死亡率的长期随访数据.
- 为政策决策提供有关机会性前列腺癌查的信息,特别是在老年男性中.
主要方法:
- 利用竞争性风险方法来分析CAP随机试验 (n=189,386) 的长期随访数据.
- 纳入英语男性竞争死亡率数据 (2021-2023),以调整死亡风险.
- 在查后15年内计算前列腺癌的累积发病率和超额净发病率.
主要成果:
- 15年后的前列腺癌累积发病率在查组为7.08%,对照组为6.94%,绝对超过0.14%.
- 超额诊断的超额净发病率估计为在单个屏幕上检测到的病例的11.7%.
- 预计过度诊断的风险随着年龄的增长而大幅增加:男性在50岁时被诊断为16%,70岁时为32%,80岁时为58%,这是由于死亡率的竞争.
结论:
- 前列腺癌的过度诊断随着年龄的增长而显著增加,主要是由于竞争的死亡风险.
- 年轻男性的过度诊断率相对较低.
- 机会主义的前列腺癌查政策,特别是针对老年男性的政策,需要重新检查.
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