摘要
目的上消化道癌症筛查已在我国高发地区推行,评价筛查效果具有重要的现实意义。本研究通过比较筛查人群和非筛查人群累积死亡率,对上消化道癌早诊早治筛查效果进行评价。方法整群选取林州市合涧、城郊、河顺和横水4个乡镇的40~69岁人群,参加2005-2012年上消化道癌筛查的人群作为干预组,共58 138人,其中干预组中筛查人群19 805人,非筛查人群38 333人。选取另外2个乡镇4个村庄(桂林镇和临淇镇的邢掌村、胡山坡村、南河村和北河村)40~69岁人群作为对照组,对照组共35 757人。参加筛查的村庄采取整群抽样的方法对40~69岁人群进行消化内镜镜检筛查,应答人群为筛查组,未应答人群为非筛查组。通过肿瘤登记数据库获取2005-2015年上消化道癌死亡病例,计算干预组和对照组上消化道癌累积死亡率,分别比较食管癌、胃癌、贲门癌死亡风险,计算相对风险及95%CI。结果筛查组检出重度不典型增生以上病变685例,病变检出率为3.46%,癌检出率为1.08%。干预组和对照组比较,死亡风险明显降低,死亡相对风险为0.87(95%CI为0.75~0.95,P=0.004);筛查组和对照组比较,死亡风险明显降低,死亡相对风险为0.60 (95%CI为0.50~0.70,P<0.001)。干预组和对照组人群分病种比较,胃癌死亡风险减低明显,死亡相对风险为0.78(95%CI为0.63-0.96,P=0.014),食管癌和贲门癌死亡风险差异无统计学意义,P>0.05;筛查组和对照组比较,食管癌、贲门癌和胃癌死亡风险均明显降低,食管癌死亡相对风险为0.60(95%CI为0.50~0.70,P<0.001),贲门癌死亡相对风险为0.54(95%CI为0.41~0.71,P<0.001),胃癌死亡相对风险为0.50(95%CI为0.34~0.71,P<0.001)。结论上消化道癌筛查可以降低癌症死亡风险,增加人群依从性有助于提高筛查效果。
OBJECTIVE Upper gastrointestinal cancer screening has been carried out for several years in high incidence areas of China,so it is of great practical significance to evaluate the effect of screening.By comparing the cumulative mortality rate of screening population and non-screening population,the screening effect of early diagnosis and early treatment of upper gastrointestinal cancer was evaluated.METHODS Intervention group was invited for endoscopic upper gastrointestinal cancer screening.Population was selected from 4 towns of Hejian,Chengjiao,Heshun and Hengshui.The control group were free of screening program.A total of 35 757 were selected from 4 villages of 2 towns,Xingzhang and Hushanpo of Guilin Town and Nanhe and Beihe of Linqi Town.All the participants aged from 40 to 69 years old were selected.In intervention group,the people who were willing to attend the program was the screening group(n=19 805),and else was the non-screening group(n=38 333).The mortality of upper gastrointestinal cancer in both the intervention group and the control group were adapted from Cancer Registry Network.The mortality risk of esophageal cancer,gastric cancer and cardiac cancer was compared,and the relative risk and 95%confidence interval were calculated.RESULTS Totally 58 138 people were in the intervention group and 35 757 were people in the control group.Among the intervention group,19 805 people participated in cancer screening and 38 333 people were absent.In the screening group,685 patients with severe dysplasia were detected from the 19 805,the detection rate of lesions was 3.46%,and the detection rate of cancer was1.08%.Compared with the control group,the relative risk of death in intervention group was 0.87(95%CI:0.75-0.95,P=0.004);compared with the control group,the risk of death was significantly reduced in the screening group,the relative risk of death was 0.60(95%CI:0.50-0.70,P<0.001).Compared with the control group,the risk of death of gastric cancer in the intervention group was significantly reduced,and the relative risk of death was 0.78(95%CI:0.63-0.96,P=0.014).There were no significant differences in the risk of death of esophageal cancer and cardiac cancer(P>0.05).Compared with the control group,the risk of death of either esophageal cancer,cardiac cancer or gastric cancer in the screening group was significantly reduced,and the relative risk of death of esophageal cancer was 0.60(95%CI:0.50-0.70,P<0.001),the relative risk of cardiac cancer was 0.54(95%CI:0.41-0.71,P<0.001),and that of gastric cancer was 0.50(95%CI:0.34-0.71,P<0.001).CONCLUSION Screening is an effective measure to reduce the death of upper GI cancer,and improving the compliance of the population is helpful to improve the screening effect.
作者
郝长青
刘志才
李变云
王进武
郭贵周
王振海
陈茹
魏文强
王贵齐
曹小琴
刘曙正
张韶凯
HAO Chang-qing;LIU Zhi-cai;LI Bian-yun;WANG Jin-wu;GUO Gui-zhou;WANG Zhen-hai;CHEN Ru;WEI Wen-qiang;WANG Gui-qi;CAO Xiao-qin;LIU Shu-zheng;ZHANG Shao-kai(Cancer Hospital,Linzhou 456550.P.R.China;National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,P.R.China;Department of Cancer Prevention and Control,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第18期1464-1469,1475,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
国家重点研发计划(2016YFC0901400,2016YFC1302800)
国家自然科学基金(81974493)
中国医学科学院医学与健康科技创新工程(2019-I2M-2-004)。
关键词
上消化道癌
筛查
早诊早治
死亡率
upper gastrointestinal cancer
cancer screening
early diagnosis and early treatment
mortality
作者简介
第一作者:郝长青,男,河南林州人,主治医师,主要从事内镜诊断和治疗的临床研究工作。E-mail:haochq@126.com;通信作者:张韶凯,男,河南郑州人,博士,副研究员,主要从事肿瘤人群防治的研究工作。Tel:86-371-65587346,E-mail:shaokaizhang@126.com。
