胃癌序贯筛查法对降低胃癌死亡率的作用

Sequence screening for declining the mortality of gastric cancer

目的 应用流行病学的方法对序贯筛查法在降低胃癌死亡方面的作用进行探讨 ,为该方法在我国的进一步推广提供依据。方法 选择胃癌序贯筛查实施现场烟台市牟平区高陵镇和水道镇 1987年 3 5岁至 70岁的永久居民2 7185人为研究对象 (其中参加序贯筛查 12 176人 ,未参加筛查 15 0 0 9人 ) ,以调查问卷的方式调查两组人群发现胃癌及死于胃癌的人数 ,并进行比较。所有胃癌患者均经过胃镜或 /和上胃肠钡餐检查结合临床症状确定诊断。结果 筛查组和非筛查组的发病率无统计学差异 (62 .85 /10万人年和 72 .82 /10万人年 ,P >0 .0 5 ) ,但两组的死亡率之间存在明显的统计学差异 (3 3 .0 5 /10万人年和 5 0 .0 2 /10万人年 ,P <0 .0 5 )。其RR值为 0 .66(95 %CI :0 .45～ 0 .98) ,也即筛查组与非筛查组比较胃癌序贯筛查法可以减少约 3 4 %的胃癌患者死亡。筛查组和非筛查组两组资料的生存分析表明筛查组的 5年、10年生存率明显高于非筛查组的 5年、10年生存率 (5 2 %和 18.3 % ,P <0 .0 5 ;45 .2 %和 0 % ,P <0 .0 5 )。结论 以胃镜为最终手段的胃癌序贯筛查法可以有效的减少死亡 ,延长胃癌患者的生存时间。

Objective To evaluate the effectiveness of sequence screening in decreasing mortality of gastric cancer by epidemiological methods in high-risk population.Methods 27185 permanent inhabitants were enrolled in the investigation in 1987,including 12176 attending sequence screeening of gastric cancer and 15009 unscreened as controls.Results The difference of incidence in screening group and in unscreening group was not insignificant (62.85/100,000 per year & 72.82/100,000 per year,P>0.05),and the difference of mortality was insignificant(33.05/100,000 person year & 50.02/100,000 person year,P<0.05).Odd ratio was 0.66(95% CI:0.45～0.98),sequence screeening of gastric cancer might reduce mortality by 34%.Survival analysis showed 5-year survival rate and 10-year survival rate in screening group was higher than that in unscreening group respectively (52% & 18.3%,P<0.05;45.3% &0%,P<0.05).Conclusions Sequence screening of gastric cancer may reduce mortality of gastric cancer and prolong survival time of gastric cancer patients.