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Trends in Incidence and 5‐year Mortality in Men with Newly Diagnosed, Metastatic Prostate Cancer—a Population‐based Analysis of 2 National Cohorts

Trends in Cancer(2018)SCI 2区

Copenhagen Univ Hosp | Canc Prevent Inst Calif | Stanford Univ Hosp

Cited 62|Views17
Abstract
BACKGROUNDEarly detection has increased prostate cancer (PCa) incidence. Randomized trials have demonstrated that early detection reduces the incidence of de novo metastatic PCa. Concurrently, life‐prolonging treatments have been introduced for patients with advanced PCa. On a populations‐based level, the authors analyzed whether early detection and improved treatments changed the incidence and 5‐year mortality of men with de novo metastatic PCa.METHODSMen diagnosed with PCa during the periods 1980 to 2011 and 1995 to 2011 were identified in the US Surveillance, Epidemiology, and End Results (SEER) program and the Danish Prostate Cancer Registry (DaPCaR), respectively, and stratified according to period of diagnosis. Age‐standardized incidence rates were calculated. Five‐year mortality rates for de novo metastatic PCa were analyzed using competing risk analysis.RESULTSTotals of 426,266 and 47,024 men were identified in SEER and DaPCaR, respectively. Of these, 29,555 and 6874 had de novo metastatic PCa. The incidence of de novo metastatic PCa decreased (from 12.0 to 4.4 per 100,000 men) in the SEER cohort (1980‐2011), whereas it increased (from 6.7 to 9.9 per 100,000 men) in the DaPCaR cohort (1995‐2011). Five‐year PCa mortality in the SEER cohort was stable for men diagnosed with de novo metastatic PCa from 1980 to 1994 and increased slightly in the latest periods studied (P < .0001), whereas it decreased by 16.6% (P < .0001) in the DaPCaR cohort.CONCLUSIONSDespite earlier detection, de novo metastatic PCa remains associated with a high risk of 5‐year disease‐specific mortality. The reduced 5‐year PCa mortality in the Danish cohort is largely explained by lead‐time. Early detection strategies do indeed decrease the incidence of de novo metastatic PCa, as observed in the SEER cohort. This achievement, however, must be weighed against the unsolved issue of overdetection and overtreatment of indolent PCa. Cancer 2018;124:2931‐8. © 2018 American Cancer Society.
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epidemiology,incidence,mass screening,metastatic,mortality,prostate-specific antigen,prostatic neoplasms
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要点】:本文分析了早期检测和改善治疗对初诊转移性前列腺癌患者的发病率及5年死亡率的影响,发现尽管早期检测减少了初诊转移性前列腺癌的发病率,但5年死亡率仍较高,且丹麦队列中的死亡率降低主要归因于领先时间效应。

方法】:通过美国监测、流行病学和结果(SEER)项目以及丹麦前列腺癌登记处(DaPCaR)的数据,对1980年至2011年和1995年至2011年期间被诊断为前列腺癌的男性进行了分析,并根据诊断时期进行分层。

实验】:研究使用了SEER和DaPCaR两个数据集,共纳入426,266名SEER队列和47,024名DaPCaR队列的男性患者,其中29,555名和6874名患有初诊转移性前列腺癌。通过计算年龄标准化发病率,并使用竞争风险分析来分析初诊转移性前列腺癌的5年死亡率。结果显示SEER队列的初诊转移性前列腺癌发病率下降,而DaPCaR队列的发病率上升;SEER队列的5年死亡率在早期稳定,近期略有上升,而DaPCaR队列的5年死亡率降低了16.6%。