我国现行大肠癌优化序贯筛查方案评价

Evaluation of optimized sequential screening program of colorectal cancer in current China

目的：评价我国现行大肠癌优化序贯筛查方案的敏感度和特异度，为进一步优化我国现行大肠癌筛查方案提供依据。方法2011年5月至2013年11月先后从浙江省嘉善县4个项目点采用随机整群抽样法抽取4个行政村作为普查区，在普查区逐村招募年龄为40～74岁的研究对象，所有研究对象应用大肠癌优化序贯筛查方案进行初筛（包括问卷调查及粪便隐血试验），并同时完成结肠镜检查，分析检测结果，计算筛查方案的灵敏度和特异度。结果共2607名研究对象同时完成初筛和肠镜检查，共检出结直肠癌20例，进展期腺瘤85例，非进展期腺瘤271例，非腺瘤性息肉141例。优化序贯筛查方案对结直肠癌、进展期腺瘤、非进展期腺瘤的灵敏度分别为70.0％（14／20）、57.6％（49／85）、36.5％（99／271），特异度分别为68.7％（1776／2587）、69.2％（1746／2522）、68.9％（1610／2336）；单独采用粪便隐血试验对结直肠癌、进展期腺瘤、非进展期腺瘤的灵敏度分别为70.0％（14／20）、47.1％（40／85）、26.6％（72／271），特异度分别为79.4％（2053／2587）、79.9％（2014／2522）、79.6％（1860／2336），与优化序贯筛查方案相比，结直肠癌、进展期腺瘤的灵敏度差异无统计学意义（χ^2值分别为0.00、1.91，P值均＞0.05）；单独采用问卷调查对结直肠癌、进展期腺瘤、非进展期腺瘤的灵敏度分别为10.0％（2／20）、14.1％（12／85）、12.9％（35／271），特异度分别为87.6％（2266／2587）、87.7％（2211／2522）、87.6％（2046／2336）。如果筛查方案去掉：慢性腹泻、慢性便秘、黏液便或血便史、慢性阑尾炎或阑尾手术史、慢性胆囊炎或胆囊手术史、不良生活事件史6个单项，对结直肠癌的灵敏度不变，进展期腺瘤、非进展期腺瘤的灵敏度下降较低，分别为70.0％（14／20）、52.9％（45／85）、31.4％（85／271），差异无统计学意义（χ^2＝0.38和1.61，P值均＞0.05）。结论我国现行的大肠癌优化序贯筛查方案有较高的灵敏度和特异度，但有进一步优化的必要和空间。

Objective To evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer, and provide evidence for the further optimization of colorectal cancer screening program. Methods Using cluster sampling method, 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013. Volunteers of 40 to 74 years old in the census were recruited, and tested by both optimized sequential screening（ including questionnaire survey and fecal occult blood test） and eolonoscopy for colorectal cancer. Sensitivity and specificity of different screening methods were calculated, respectively. Results A total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time. 20 eoloreetal caneer cases, 85 advanced adenoma cases, 271 non-advanced adenomas eases, and 141 non-adenomatous polyps eases were detected. Sensitivity of optimized sequential screening for eolorectal cancer, advanced adenomas, and non-advanced adenomas were 70. 0% （14/20） , 57.6% （49/85） and 36. 5% （99/271 ）, specificity was 68.7% （1 776/2 587 ）, 69.2% （ 1 746/2 522） and 68. 9% （ 1 610/2 336）, respectively. Sensitivity of the fecal occult blood test of eolorectal cancer, advanced adenomas and non-advanced adenomas were 70. 0% （ 14/20 ） , 47. 1% （40/85） and 26. 6% （72/271） , specificity was 79.4% （2 053/2 587）, 79.9% （2 014/2 522） and 79. 6% （ 1 860/2 336）. The sensitivity of fecal occuh blood test and those of optimized sequential screening for colorectal cancer, advanced adenomas was not significent（χ^2 = 0. 00,1.91, all P values 〉 0. 05 ）. Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10. 0% （2/20）, 14. 1% （ 12/85 ） , 12. 9% （35/271）, specificity was 87.6% （2 266/2 587）, 87.7% （2 211/2 522）, 87.6% （2 046/2 336）. There were no significant difference between non-advanced adenomas. The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs： chronic diarrhea, chronic constipation, mucus or bloody history, history of chronic appendicitis or appendectomy surgery, chronic cholecystitis or gallbladder surgery, adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70. 0% （14/20） ,52.9% （45/85）, 31.4% （ 85/271 ） （ χ^2 = 0. 38, 1.61, all P values 〉 0. 05 ）. Conclusion Current optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity. However, further optimization is viable and necessary.