| 社区群体性早筛联合双向转诊模式在诊断早期前列腺癌中的优势 |
| 投稿时间：2025-03-17 修订日期：2025-05-25 点此下载全文 |
| 引用本文：徐耀宗,颜文韬,余皖东,周英豪,章俊.社区群体性早筛联合双向转诊模式在诊断早期前列腺癌中的优势[J].医学研究杂志,2025,54(10):89-92, 98 |
| DOI：
10.11969/j.issn.1673-548X.2025.10.016 |
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| 基金项目:上海市卫生健康系统重点学科建设项目(2024ZDXK0047)；闵行区公共卫生重点学科资助项目(MGWXK2023-07)；复旦-闵行健康联合体合作研究项目(2022FM07) |
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| 中文摘要:目的 探讨社区群体性早筛联合双向转诊模式相较传统就诊机会性筛查模式在诊断早期前列腺癌的差异性。方法 2022年8月~2024年4月对复旦大学附属上海市第五人民医院康联体内的5家社区卫生服务中心的高危老年男性开展前列腺特异性抗原(prostate specific antigen, PSA)群体性筛查共计12815人,发现PSA>4.0ng/ml的异常患者共1005例,采取双向转诊模式到复旦大学附属上海市第五人民医院进一步评估,符合指征同意穿刺者予以活检,前列腺活检数445例,平均年龄为65.6±6.8岁,收集临床资料,记为社区群体性早筛联合双向转诊模式组(A组)；同期对因下尿路症状就诊于复旦大学附属上海市第五人民医院的高危老年男性开展PSA的机会性筛查模式共计4600人,PSA异常者700例,进一步评估符合指征同意穿刺者予以活检,前列腺活检数270例,平均年龄为64.8±6.4岁,收集临床资料,记为传统就诊机会性筛查模式组(B组)。比较两组患者的基线特征及前列腺癌阳性率、临床分期及病理分级。结果 两组患者的年龄、PSA水平、家族史、体重指数(body mass index, BMI)、婚姻状态及教育程度等比较,差异均无统计学意义(P＞0.05)；A组阳性例数为160例,癌症阳性率为35.9%,B组阳性例数为90例,癌症阳性率为33.3%,两组比较差异无统计学意义(P=0.652)；A组临床分期≤T2N0M0期例数为100例,在本组确诊例数占比62.5%,B组临床分期≤T2N0M0期例数为35例,在本组确诊例数占比38.9%,两组比较差异有统计学意义(P=0.023)；A组国际泌尿病理学会(International Society of Urological Pathology, ISUP)分级≤3级例数为105例,在本组确诊例数占比65.6%,B组病理分级ISUP分级≤3级例数为30例,在本组确诊例数占比33.3%,两组比较差异有统计学意义(P=0.002)。结论 社区群体性早筛联合双向转诊模式相较传统就诊机会性筛查模式在前列腺癌阳性率方面未见差异,但在诊断早期前列腺癌方面具有优势,该模式进一步推广有望改善我国前列腺癌患者分期偏晚、总体预后差的现状。 |
| 中文关键词:前列腺癌 PSA筛查 前列腺活检 双向转诊 |
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| Advantages of Community-based Population-wide Early Screening Combined with Two-way Referral Model in Diagnosing Early-stage Prostate Cancer. |
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| Abstract:Objective To explore the differences between community-based population-wide early screening combined with two-way referral model and the traditional opportunistic screening model for early diagnosis of early-stage prostate cancer. Methods From August 2022 to April 2024,12815high-risk elderly males within the Fifth People′s Hospital of Shanghai, Fudan University healthcare alliance underwent population-wide prostate-specific antigen (PSA) screening across five community health centers. Among them, 1005 cases with PSA>4.0ng/ml were identified and referred via a two-way referral model to the Fifth People′s Hospital of Shanghai, Fudan University for further evaluation. Prostate biopsies were performed on 445 eligible patients who consented (mean age was 65.6±6.8 years), and clinical data were collected as the community-based population-wide early screening combined with two-way referral model group (Group A). During the same period, 4600high-risk elderly males with lower urinary tract symptoms underwent opportunistic PSA screening at the Fifth People′s Hospital of Shanghai, Fudan University identifying 700 cases with abnormal PSA levels. Biopsies were performed on 270 eligible patients who consented (mean age was 64.8±6.4 years), and clinical data were collected as the traditional opportunistic screening model group (Group B). Baseline characteristics, positive rate of prostate cancer, clinical stages, and pathological grades were compared between the two groups. Results There were no statistically significant differences in age, PSA levels, family history, body mass index (BMI), marital status and education level between the groups. There were 160 positive cases in Group A, the positive rate was 35.9%, while there were 90 positive cases in Group B, the positive rate was 33.3%, with no significant statistical difference (P=0.652). In Group A, 100 cases (62.5% of diagnosed cases) were classified as clinical stage ≤T2N0M0, compared to 35 cases (38.9%) in Group B, showing a significant statistical difference (P=0.023). Group A had 105 cases (65.6% of diagnosed cases) with International Society of Urological Pathology (ISUP) grade ≤3, while Group B had 30 cases (33.3%), showing a significant statistical difference (P=0.002). Conclusion Community-based population-wide early screening combined with two-way referral model showed no difference in the positive rate of prostate cancer compared to traditional opportunistic screening but exhibited advantages in diagnosing early-stage prostate cancer. Wider adoption of this model may improve the current status of delayed staging and poor prognosis among prostate cancer patients in China. |
| keywords:Prostate cancer PSA screening Prostate biopsy Two-way referral |
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