食管癌高发区1.5万队列人群内镜筛查与食管癌胃癌死亡研究

Endoscopic Screening Cohort Study of 15,000 Subjects in High-risk Area of Esophageal Cancer and Investigation of Death Caused by Esophageal Cancer and Gastric Cancer

目的:磁县是我国北方食管癌高发区河北医科大学第四医院肿瘤研宄所自2001年开展40～69岁为目标人群的内镜碘染色队列筛查,以期降低食管癌高发区的发病率和死亡率方法:2001年10月～2002年10月选择磁县4个乡,干预人群22 016例,对照人群33 410例,总覆盖人群5.5万,其中干预人群40～69岁中男性3 257例,女性3 339例,对照人群中男性4 299例,女性4 430例。干预人群采用内镜碘染色筛查,筛查率53.2%。内镜碘染色筛查食管鳞状上皮和贲门腺上皮原位癌及黏膜内癌97例,食管和贲门重度不典型增生102例;对照人群观察肿瘤自然发病率和死亡率。肿瘤发病死亡登记编码应用ICD-0-2。2008年6月～9月根据全县肿瘤发病死亡登记数据库,对该队列人群进行随访核实。结果:干预人群食管癌死亡133例,胃癌48例,对照组人群分别为259例和37例。男性食管癌死亡相对危险度RR=0.76,95%CI(0.59～0.98),P=0.038;女性RR=0.51,95%CI(0.35～0.75),P=0.000。男性胃癌死亡相对危险度RR=2.45,95%CI(1.40～4.29),P=0.010;女性RR=0.99,95%CI(0.47～1.99),P=0.906。结论:食管癌高发区内镜碘染色大人群队列筛查历经6年时间演变,男性和女性食管癌死亡危险度下降,有显著性差异,但内镜筛查对胃癌死亡危险未见到保护作用。

Objective： Cixian is a high-risk area of esophageal cancer in northern China. The incidencerate of esophageal cancer in the male and female population was 127/100,000 and 93/100,000 in 2004, andthat of gastric cancer was 72/100,000 and 36/100,000. Since 2001, with a special fund for the support of thisarea, we carried out an endoscopic screening cohort study in the target population of 40-69 years old. The objectivewas to reduce the incidence and mortality of esophageal cancer in this area. Methods： In October2001, four towns of Cixian were selected as the target areas. A total of 22,016 subjects were assigned into theintervention group and 33,410 subjects were assigned into the control group. There were 3,257 males and 3,339 females in the intervention group and 4,299 males and 4,430 females in the control group. The endoscopicscreening rate was 53.2%. The control group was set to monitor the natural incidence of cancer and death.ICD-O-2 version was used for tumor incidence and death registration. Between June 2008 and September2008, the cohort groups were followed up to comfirm the incidence and mortality. Results： In the interventiongroup, there were 133 esophageal cancer deaths and 48 gastric cancer deaths. In the control group, therewere 259 esophageal cancer deaths and 37 gastric cancer deaths. The relative risk of esophageal cancerdeath was 0.76 [95% CI （0.59-0.98）, P=0.038] in male subjects and 0.51 [95% CI （0.35-0.75）, P=0.000] in female subjects. The relative risk of gastric cancer death was 2.45 [95% CI （1.40-4.29）, P=0.01] in male subjectsand 0.99 [95% CI （0.47-1.99）, P=0.906]. Conclusion： The cohort study last for 6 years. Male and femalesophageal cancer deaths have decreased. However, screening with endoscopic iodine staining has no protectiveeffect on death from gastric cancer