NEJM Audio Summary - March 15, 2012

Excerpted Script

0'47"| "Prostate-Cancer Mortality at 11 Years of Follow-up" by  Fritz Schröder from Erasmus University Medical Center, Rotterdam in the Netherlands.
The authors updated prostate-cancer mortality in the European Randomized Study of Screening for Prostate Cancer with 2 additional years of follow-up.  After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% , and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62. To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected.  Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality.
2'13"| Anthony Miller from University of Toronto, Ontario,Canada, writes the editorial that we are left with an unsatisfactory situation, in which many practitioners will think there are insufficient data to recommend abandoning PSA screening for prostate cancer. However, the findings of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial, a similar update on prostate-cancer death, are more applicable to the situation in the United States, since the European Randomized Study of Screening for Prostate Cancer was conducted in a largely PSA-naive population. Therefore, an intensification of PSA screening would be unwise, and the editorialist think it would be advisable to follow the preliminary recommendations of the U.S. Preventive Services Task Force.

上掲書では、要約をさらに下記4点に絞って読むことを推奨している。

1. METHODSの「最後から一文前(penultimate sentence)」あたりでPrimary Endpointを把握する。
2. CONCLUSIONSの最初の文からPEに関連した結論を把握する。increase, decrease, reduceなどの単語がマーカー。
3. RESULTSの最初か２番目の文から比（risk ratio, hazard ratio, odds ratio）、信頼区間、P値を読む。
4. 研究デザインをMETHODSの頭で確認する。randomized clinical trial, randomly assigned, cohort study, case-control studyなどがマーカー。Critical readingの際は、CONSORTやSTROBEなどの各声明を参考に。

それぞれ漢字１字で代表させると、終結比設（zhōng jié bǐ shè）とでもなろうか、それぞれを当該論文の要約に当たって拾ってみる。目の動きは、METHODSの終わりのある中央部から、CONCLUSIONS、RESULTSと遡上してMETHODSの頭に帰る。

1. 終: mortality from prostate cancer
2. 結: significantly reduced
3. 比: rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001
4. 設: randomly assigned

確かに慣れれば、1分ほどで要約の内容は、把握できそうだが、聴き取る場合には、数字の聴解がネックになりそう。