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JCO：中年人PSA基线水平高，未来发生前列腺癌几率大

2016年06月18日

编译：南南和北北

来源：桓兴医讯

目的（Purpose）

在未进行筛查的瑞典人口中，中年前列腺特异性抗原（PSA）水平预示着将来前列腺癌死亡率。在机会性筛查美国人群中，我们旨在了解中年期间PSA基线水平是否可预测致命前列腺癌。

Prostate-specific antigen (PSA) level in midlife predicted future prostate cancer (PCa) mortality in an unscreened Swedish population. Our purpose was to determine if a baseline PSA level during midlife predicts lethal PCa in a US population with opportunistic screening.

材料与方法（Materials and Methods）

我们在“医生健康研究”中，进行了一项巢式病例对照研究，研究对象为“医生健康研究”随机分组前抽血且年龄40-59岁男性，“医生健康研究”是一项阿司匹林和β-胡萝卜素的随机、安慰剂对照试验，在22071名美国男医生中进行，开始于1982年，随后转变为一项随访30年的前瞻性队列。234名前列腺癌和711名年龄匹配的对照者有PSA基线水平。出现致命前列腺癌的71名参试者再与213名对照匹配。采用条件逻辑回归分析，估算PSA基线水平与致命前列腺癌风险之间相关性的比值比及AUC值（接受者操作特征曲线下面积），可信区间CI为95%。

We conducted a nested case-control study among men age 40 to 59 years who gave blood before random assignment in the Physicians’ Health Study, a randomized, placebo-controlled trial of aspirin and β-carotene among 22,071 US male physicians initiated in 1982 and then transitioned into a prospective cohort with 30 years of follow-up. Baseline PSA levels were available for 234 patients with PCa and 711 age-matched controls. Seventy-one participants who developed lethal PCa were rematched to 213 controls. Conditional logistic regression was used to estimate odds ratios and the area under the receiver operating characteristic curve, with 95% CIs, of the association between baseline PSA and risk of lethal PCa.

结果（Results）

40-49岁、50-54岁、55-59岁男性对照中，PSA中位值分别为0.68、0.88、0.96mg/mL。致命前列腺癌风险与中年PSA基线水平强相关：PSA水平在>90百分位相比于PSA水平在≤中位值，40-49岁时比值比（95%CIs）为8.7（1.0-78.2），50-54岁时为12.6（1.4-110.4），55-59岁时6.9（2.5-19.1）。在40-49岁时PSA超过中位值的男性中，以后共计有82%出现致命前列腺癌；在50-54岁时PSA超过中位值的男性中，以后共计有71%出现致命前列腺癌；在55-59岁时PSA超过中位值的男性中，以后共计有86%出现致命前列腺癌。

Median PSA among controls was 0.68, 0.88, and 0.96 ng/mL for men age 40 to 49, 50 to 54, and 55 to 59 years, respectively. Risk of lethal PCa was strongly associated with baseline PSA in midlife: odds ratios (95% CIs) comparing PSA in the > 90th percentile versus less than or equal to median were 8.7 (1.0 to 78.2) at 40 to 49 years, 12.6 (1.4 to 110.4) at 50 to 54 years, and 6.9 (2.5 to 19.1) at 55 to 59 years. A total of 82%, 71%, and 86% of lethal cases occurred in men with PSA above the median at ages 40 to 49, 50 to 54, and 55 to 59 years, respectively.

结论（Conclusion）

在机会性筛查的美国人队列中，中年PSA水平强烈预示着未来致命前列腺癌。在45-59岁的男性中，应考虑在中年PSA基础上进行危险分层筛查。

PSA levels in midlife strongly predict future lethal PCa in a US cohort subject to opportunistic screening. Risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.

责任编辑：Dr.q