2005-2018年林州市上消化道癌筛查结果分析

Analysis of screening results of upper gastrointestinal cancer in Linzhou City from 2005 to 2018

目的林州市是我国食管癌防治重点地区之一,食管癌和胃癌发病和死亡均占本地区全部恶性肿瘤>50%。本研究对2005-2018年林州市高危人群上消化道癌早诊早治结果进行分析,评价人群上消化道癌筛查模式的利与弊。方法选择2005-2018年林州市合涧、横水、任村、河顺、东岗和城郊等乡镇户籍人口中112342名40~69岁高危人群作为筛查对象,按照《中国癌症早诊早治筛查技术方案(2005版)》要求,进行高危人群筛查。结果共筛查49851名高危人群,其中初次筛查人群42438名,筛查率为37.78%,各年龄组筛查率差异有统计学意义,χ^2=597.354,P<0.001。初次筛查发现病变人群1465例,检出率为3.45%,各年龄组病变检出率差异有统计学意义,χ^2=1016.946,P<0.001;其中早期病变1332例,检出率为3.14%,早诊率为90.92%。癌前病变845例,检出率为1.99%;早期癌487例,检出率为1.15%;进展期癌133例,检出率为0.31%。复查发现新发病例273例,检出率为3.68%。食管病变检出782例,其中早期病变745例,食管癌早诊率为95.27%;贲门病变检出591例,其中早期病变519例,贲门癌早诊率为87.82%;胃病变检出92例,其中早期病变68例,胃癌早诊率为73.91%,各部位早诊率间差异有统计学意义,χ^2=57.045,P<0.001。2010-2018年整体、癌前病变和癌的治疗率分别为87.36%(χ^2=30.096,P<0.001)、83.09%(χ^2=38.845,P<0.001)和94.32%(χ^2=1.239,P<0.001),均高于2005-2010年度治疗情况。2005-2010年(χ^2=103.836,P<0.001)、2010-2018年(χ^2=24.053,P<0.001)以及2005-2018年(χ^2=130.231,P<0.001)癌前病变治疗率均低于癌症治疗率。结论林州市在上消化道癌早期诊断和早期治疗方面取得了显著进展,但检出率仍有待提高。将人口普查和机会性筛查结合起来,可以极大提高检出率,促进早诊早治。

OBJECTIVE Linzhou City is one of the key areas of esophageal cancer prevention and control in China.The incidence and death of esophageal cancer and gastric cancer account for more than 50%of all malignant tumors in this region.This study analyze the results of early diagnosis and treatment of upper gastrointestinal cancer in high-risk population in Linzhou City from 2005 to 2018,and evaluated the advantages and disadvantages of screening mode of upper gastrointestinal cancer.METHODS A total of 112342 high-risk population aged 40-69 years old in Hejian,Hengshui,Rencun,Heshun,Donggang,and Chengjiao townships of Linzhou City from 2005 to 2018 as the screening objects.According to the requirements of"China’s early diagnosis and early treatment screening technology program(2005 Edition)",the high-risk groups were screened.RESULTS A total of 49851 high-risk groups were screened,among which42438 were screened for the first time,and the screening rate was 37.78%.The difference of screening rate among different age groups was statistically significant,χ^2=597.354,P<0.001.There were 1465 patients with pathological changes in the first screening,the detection rate was 3.45%.There was significant difference in the detection rate among different age groups,χ^2=1016.946,P<0.001.There were 1332 cases of early lesions,the detection rate was 3.14%,and the early diagnosis rate was 90.92%.The detection rate of 845 cases of precancerous lesions was 1.99%.In 487 cases of early cancer,the detection rate was 1.15%.The detection rate of 133 patients with advanced carcinoma was 0.31%.Reexamination found 273 new cases,the detection rate was 3.68%.A total of 782 cases of esophageal lesions were detected,including 745 cases of early lesions.The early diagnosis rate of esophageal cancer was 95.27%.Cardia lesions were detected in 591 cases,including 519 cases with early lesions,and the early diagnosis rate of cardia cancer was 87.82%.A total of92 cases of gastric diseases were detected,including 68 cases of early lesions.The early diagnosis rate of gastric cancer was 73.91%.The early diagnosis rate of different parts was statistically significant,χ^2=57.045,P<0.001.From 2010 to 2018,the treatment rates of overall,precancerous lesions and cancer were 87.36%(χ^2=30.096,P<0.001),83.09%(χ^2=38.845,P<0.001)and 94.32%(χ^2=1.239,P<0.001),respectively,which were higher than those in 2005-2010.The treatment rates of precancerous lesions in 2005-2010(χ^2=103.836,P<0.001),2010-2018(χ^2=24.053,P<0.001)and 2005-2018(χ^2=130.231,P<0.001)were lower than those of cancer treatment.CONCLUSIONS Linzhou City has made remarkable progress in the early diagnosis and treatment of upper gastrointestinal cancer,but the detection rate still needs to be improved.The combination of census and opportunistic screening can greatly improve the detection rate and promote early diagnosis and treatment.