山东省2013-2016年农村居民食管癌社会性筛查结果分析

Analyzing the result of esophageal cancer screening among rural residents in Shandong province,2013-2016

目的山东省自2006年开始承担国家食管癌早诊早治项目,取得了良好的社会效益。本研究旨在分析山东省2013-2016年食管癌早诊早治项目筛查结果,探讨食管癌筛查的改进策略。方法采用整群随机抽样法选取2013-2016年山东省内9个项目点的目标人群,年龄40~69岁,对符合条件的受检者采用内镜下碘染色观察和指示性活检技术进行筛查;对筛查结果进行分析,计算检出率、早诊率等,并进行统计检验。结果 9个项目点共完成筛查107 431人次,检出重度异型增生及以上病例1 093例,检出率为1.02%,其中早期病例941例,早诊率为86.09%;食管各级病变例数大致呈"金字塔"型分布,筛查可发现大量癌前病变和早期食管癌患者;社会性筛查带动了项目点食管癌诊治水平的提高,但不同地区间的检出率差异较大(P<0.05),食管癌检出率与当地发病率密切相关;与机会性筛查相比,食管癌社会性筛查具有"检出率低、早诊率高"的特点。结论食管癌社会性筛查具有良好的社会效益,应继续推广;推动"社会性筛查"和"机会性筛查"融合发展以及"补需方"和"补供方"的有机结合,有利于提高检出率和早诊率,促进筛查工作的可持续发展。

OBJECTIVE Shandong province＇s upper gastrointestinal cancer screening project which started in 2006 had achieved great social benefit. This article aimed to investigate the results of esophageal cancer screening among rural residents in Shandong Province from 2013 to 2016, and explore the improvement strategy of esophageal cancer screening. METHODS Random cluster sampling method was used to select target population of screening. Endoscope iodine staining and indicative biopsy methods were used for cancer screening among eligible people. According to certain conditions, 9 project sites were enrolled in this study. Detection rate, early detection rate were calculated and compared between dif- ferent years and areas. RESULTS Totally 107 431 people were screened, and1 093 people with above serious dysplasia or cancer in situ were detected and the detection rate was 1.02 %. The sum of serious dysplasia or cancer in situ and early cancer was 941, and the early detection rate was 86.09%. The number of patients in different levels of esophageal lesions showed a pyramid pattern, amount of precancerosis and early cancer patients could be detected by screening. Social screening promoted the levels of cancer diagnostis and treatment, but the detection rates were various among different sites. Compared with opportunistic screening, social screening revealed the characters of ＂low detection rate＂ and ＂high early detection rate＂. CONCLUSIONS Esophageal cancer＇s social screening has favorable social benefit, and it was worth further promoting. To motivate the integration development of ＂social screening＂ and ＂opportunistic screening＂ and the combine of ＂subsidizing suppliers＂ and ＂subsidizing demanders＂ were favorable to the sustainable development of cancer screening.