摘要
目的了解食管癌高发区人群筛查现状,为食管癌筛查方案优化提供真实世界证据。方法依托河北省磁县、河南省林州市、山东省肥城市、四川省盐亭县和江苏省扬中市食管癌筛查人群构建多中心队列,选取2005-2012年所有受邀参与内镜筛查的40~69岁、无肿瘤史的常住居民为研究对象。通过筛查依从性、基线检出率、危险因素、进展风险等多个指标探讨食管癌筛查的起始年龄、筛查间隔等问题。结果2005-2012年共有284476人受邀参加筛查,其中100880人参与了内镜检查,筛查依从性为35.46%。女性依从性(38.95%)高于男性(31.95%);50~59岁人群依从性最高(39.26%),40~49岁依从性最低(31.61%);肥城市依从性最高(55.63%),扬中市依从性最低(27.74%),性别、年龄和地区依从性差异有统计学意义,均P<0.001。在基线筛查人群中,低级别上皮内瘤变、高级别上皮内瘤变和食管癌分别检出8011例、960例和369例,检出率分别为7.94%、0.95%和0.37%。男性、高龄、吸烟等是食管癌和癌前病变共同的危险因素,均P<0.001。中位随访12.15年后,低级别和高级别上皮内瘤变患者进展为食管癌的风险分别是正常人群的5.00倍(HR=5.00,95%CI:4.37~5.72)和26.41倍(HR=26.41,95%CI:22.54~30.94),发生食管癌死亡的风险分别是正常人群的3.37倍(HR=3.37,95%CI:2.77~4.10)和17.85倍(HR=17.85,95%CI:14.32~22.26)。低级别上皮内瘤变患者的食管癌发病率随着随访时间延长不断升高,死亡率在随访3年后缓慢上升,随访5年后加速上升。结论提高食管癌筛查的起始年龄可以降低筛查负担并提高筛查的依从性和检出率。筛查方案的优化应结合危险因素制定个体化的筛查方案,并根据病理诊断制定合理的治疗和监测方案。
Objective To understand the status of population-based screening in high risk areas of esophageal cancer,and to provide real-world evidence for the optimization of esophageal cancer screening programs.Methods A multi-center cohort was constructed based on the screening population of esophageal cancer in Cixian County of Hebei Province,Linzhou City of Henan Province,Feicheng City of Shandong Province,Yanting County of Sichuan Province,and Yangzhong City of Jiangsu Province from January 1,2005,to December 31,2012,and all permanent residents aged 40-69 who were invited to participate in endoscopic screening were regarded as the target population.The starting age and screening interval of esophageal cancer screening were discussed through multiple indicators such as screening compliance,baseline detection rate,risk factors,and risk of progression.Results A total of 284476 people were invited to participate in the screening from 2005 to 2012,of which 100880 people took endoscopy,with a screening compliance rate of 35.46%.Female compliance(38.95%)was higher than male(31.95%);the highest compliance was found in the 50-59 years old group(39.26%).and the lowest in the 40-49 years old group(31.61%);the highest compliance was found in Feicheng City(55.63%),and the lowest in Yangzhong City(27.74%),and the differences in compliance by gender,age,and region were statistically significant(P<0.001).In the baseline screening population,8011,960 and 369 cases of low-grade intraepithelial neoplasia,high-grade epithelial neoplasia and esophageal cancer were detected,with detection rates of 7.94%,0.95%and 0.37%,respectively.Male,advanced age,and smoking are common risk factors for esophageal cancer and precancerous lesions(P<0.001).During a median follow-up of 12.15 years,the risk of progression to esophageal cancer in patients with low-grade and high-grade intraepithelial neoplasia yeas 5.00 times(HR=5.00,95%CI:4.37-5.72)and26.41 times(HR=26.41,95%CI:22.54-30.94)that of the normal population,and the risk of death from esophageal can
作者
陈茹
李琰琰
郝长青
宋国慧
华召来
李军
魏文强
CHEN Ru;LI Yanyan;HAO Changqing;SONG Guohui;HUA Zhaolai;LI Jun;WEI Wenqiang(National Central Cancer Registry,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Cancer Center,Feicheng People's Hospital,Shandong 271600,China;Department of Endoscopy,Linzhou Cancer Hospital,Linzhou,Henan 456550,China;Department of Epidemiology,Cancer Institute/Hospital of Ci County,Hebei 056500,China;Cancer Institute of Yangzhong City,People's Hospital of Yangzhong City,Yangzhong,Jiangsu 212200,China;Cancer Prevention and Treatment Office,Yanting Cancer Hospital,Sichuan 621600,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2023年第23期1401-1406,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
国家科技基础资源调查专项(2019FY101101)
国家自然科学基金(81974493,81903403)
北京市自然科学基金(7204294)
中国医学科学院医学与健康科技创新工程(2021-I2M-1-010,2021-I2M-1-013)。
关键词
食管癌
癌前病变
检出率
吸烟
进展风险
esophageal cancer
precancerous lesions
detection rate
smoking
progression risk
