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作者：SCI天天读
SCI
26 April 2024
Cancer Stage Compared With Mortality as End Pointsin Randomized Clinical Trials of Cancer Screening: A Systematic Review and Meta-Analysis
(JAMA, IF: 120.7)
Feng X, Zahed H, Onwuka J, et al: Cancer Stage Compared With Mortality as End Points in Randomized Clinical Trials of Cancer Screening: A Systematic Review and Meta-Analysis. JAMA e245814, 2024
Importance 重要性
Randomized clinical trials of cancer screening typically use cancer-specific mortality as the primary end point. The incidence of stage III-IV cancer is a potential alternative end point that may accelerate completion of randomized clinical trials of cancer screening.
癌症筛查的随机临床试验通常使用癌症特异性死亡率作为主要终点。III-IV 期癌症的发病率是一个潜在的替代终点，可能会加速完成癌症筛查的随机临床试验。
Objective 目的
To compare cancer-specific mortality with stage III-IV cancer as end points in randomized clinical trials of cancer screening.
比较癌症特异性死亡率和 III-IV 期癌症作为癌症筛查随机临床试验的终点。
Design, setting, and participants 设计、设置和参与者
This meta-analysis included 41 randomized clinical trials of cancer screening conducted in Europe, North America, and Asia published through February 19, 2024. Data extracted included numbers of participants, cancer diagnoses, and cancer deaths in the intervention and comparison groups. For each clinical trial, the effect of screening was calculated as the percentage reduction between the intervention and comparison groups in the incidence of participants with cancer-specific mortality and stage III-IV cancer.
这项荟萃分析包括在欧洲、北美和亚洲进行的41项癌症筛查随机临床试验，发表于2024年2月19日。提取的数据包括干预组和对照组的参与者人数、癌症诊断和癌症死亡人数。对于每个临床试验，筛查的效果计算为干预组和对照组之间癌症特异性死亡率和 III-IV 期癌症患者发病率的百分比降低。
Exposures 暴露
Randomization to a cancer screening test or to a comparison group in a clinical trial of cancer screening.
随机分配到癌症筛查试验或临床癌症筛查试验的对照组。主要结果和措施: 使用 Pearson 相关系数与95% 可信区间、线性回归和固定效应荟萃分析比较癌症特异性死亡率和 III-IV 期癌症发病率的终点。
Results 结果
The included randomized clinical trials tested benefits of screening for breast (n = 6), colorectal (n = 11), lung (n = 12), ovarian (n = 4), prostate (n = 4), and other cancers (n = 4). Correlation between reductions in cancer-specific mortality and stage III-IV cancer varied by cancer type (I2 = 65%; P = .02). Correlation was highest for trials that screened for ovarian (Pearson ρ = 0.99 [95% CI, 0.51-1.00]) and lung (Pearson ρ = 0.92 [95% CI, 0.72-0.98]) cancers, moderate for breast cancer (Pearson ρ = 0.70 [95% CI, -0.26 to 0.96]), and weak for colorectal (Pearson ρ = 0.39 [95% CI, -0.27 to 0.80]) and prostate (Pearson ρ = -0.69 [95% CI, -0.99 to 0.81]) cancers. Slopes from linear regression were estimated as 1.15 for ovarian cancer, 0.75 for lung cancer, 0.40 for colorectal cancer, 0.28 for breast cancer, and -3.58 for prostate cancer, suggesting that a given magnitude of reduction in incidence of stage III-IV cancer produced different magnitudes of change in incidence of cancer-specific mortality (P for heterogeneity = .004).
纳入的随机临床试验测试了筛查乳腺癌(n = 6) ，结直肠癌(n = 11) ，肺癌(n = 12) ，卵巢癌(n = 4) ，前列腺癌(n = 4)和其他癌症(n = 4)的益处。癌症特异性死亡率降低与III-IV 期癌症的相关性因癌症类型而异(I2 = 65% ; P = .02)。对于筛查卵巢(Pearson ρ = 0.99[95% CI，0.51-1.00])和肺(Pearson ρ = 0.92[95% CI，0.72-0.98])癌症，中期乳腺癌(Pearson ρ = 0.70[95% CI，-0.26至0.96])和结直肠(Pearson ρ = 0.39[95% CI，-0.27至0.80])和前列腺(Pearson ρ = -0.69[95% CI，-0.99至0.81])癌症。据估计，卵巢癌的线性回归斜率为1.15，肺癌为0.75，大肠癌为0.40，乳腺癌为0.28，前列腺癌为-3.58，这表明给定的 III-IV 期癌症发病率的降低产生了不同程度的癌症特异性死亡率的变化(异质性 P = .004)。
Conclusions and relevance 结论和相关性
In randomized clinical trials of cancer screening, incidence of late-stage cancer may be a suitable alternative end point to cancer-specific mortality for some cancer types, but is not suitable for others. These results have implications for clinical trials of multicancer screening tests.
在癌症筛查的随机临床试验中，晚期癌症的发病率可能是某些癌症特异性死亡率的一个合适的替代终点，但不适用于其他类型的癌症。这些结果对多肿瘤筛查试验的临床试验有一定的意义。
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