BMJ:定期宫颈抹片筛查可显著提高宫颈癌治愈率

2012-03-09 MedSci MedSci原创

近日,瑞典乌普萨拉大学的研究人员发现,女性定期接受宫颈抹片筛查可使宫颈癌治愈率由66%升高至92%。相关论文发表在国际学术期刊《英国医学杂志》(British Medical Journal)上。 研究者对1999~2001年期间1,230例被诊断为宫颈癌的女性平均随访8.5年,旨在确定通过筛查发现宫颈癌究竟是能够改善预后,还是仅能早期诊断而不能推迟死亡。研究者将入组患者分为两组,即筛查发现

近日,瑞典乌普萨拉大学的研究人员发现,女性定期接受宫颈抹片筛查可使宫颈癌治愈率由66%升高至92%。相关论文发表在国际学术期刊《英国医学杂志》(British Medical Journal)上。

研究者对1999~2001年期间1,230例被诊断为宫颈癌的女性平均随访8.5年,旨在确定通过筛查发现宫颈癌究竟是能够改善预后,还是仅能早期诊断而不能推迟死亡。研究者将入组患者分为两组,即筛查发现组(在获得诊断前1~6个月已通过宫颈抹片筛查发现异常)和有症状组(所有其余患者)。主要预后指标为治愈患者比例和5年相对生存率。

结果显示,在筛查发现组患者中,92%被治愈[95%置信区间(CI),75%~98%],而在根据症状获得诊断的患者中,治愈患者所占比例仅为66%(95%CI,62%~70%)。两组间的绝对差异达到26%(95%CI,16%~36%),具有统计学显著性。

在有症状组患者中,根据建议如期接受宫颈癌筛查者的治愈比例又高于逾期接受筛查者,绝对差异为14%(95%CI,6%~23%)。此外,在373例死于宫颈癌的患者中,75%并未按照推荐的时间表接受宫颈癌筛查。

除了小细胞癌之外,各种组织病理学类型的治愈率均相似。治愈率与国际妇产科联盟(FIGO)分期高度相关。不过,即使在校正诊断时的FIGO分期后,筛查发现组患者的治愈率仍然显著高于有症状组,绝对差异为15%(95%CI,7%~22%)。

研究者总结认为,宫颈癌筛查可显著提高宫颈癌治愈率。虽然有一些混淆因素未能被排除,但这并不会带来时间偏倚,而且其影响大于分期下降的效应。在制订筛查计划时应当考虑到治愈率的因素。

Screening and cervical cancer cure: population based cohort study.

Andrae B, Andersson TM, Lambert PC, Kemetli L, Silfverdal L, Strander B, Ryd W, Dillner J, Trnberg S, Sparén P.

OBJECTIVE: To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

DESIGN: Nationwide population based cohort study.

SETTING: Sweden.

PARTICIPANTS: All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years.

MAIN OUTCOME MEASURES: Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.

RESULTS: In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).

CONCLUSIONS: Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.

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    2013-01-09 gaoxiaoe
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    2012-07-29 cenghis
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    2012-03-11 一闲