肥城市上消化道癌内镜筛查的长期效果分析

Long-term effects of endoscopic screening for upper gastrointestinal cancer in Feicheng

目的上消化道癌是我国常见的恶性肿瘤之一,内镜检查是发现早期癌的有效手段。本研究旨在分析上消化道癌内镜筛查在高危地区降低上消化道癌死亡率的有效性。方法回顾性分析2006-2015年肥城市40~69岁人群上消化道癌发病和死亡情况,所有受邀人群为干预组,其中以受邀并实际参加内镜筛查者作为筛查组,受邀但未接受筛查者作为未筛查组,同期未被邀请参加筛查项目覆盖地区的适龄人群为对照组。计算和比较三组间上消化道癌及全部恶性肿瘤的累积死亡率。结果干预组目标人群42 188人,其中筛查组23 470人,未筛查组18 718人,共发生终点事件802例,其中上消化道癌339例,占全恶性肿瘤死亡42.27%;对照组目标人群58 006人,共发生终点事件2 584例,其中上消化道癌1 194例,占全恶性肿瘤死亡46.21%;筛查组与对照组在食管癌、胃癌和全恶性肿瘤的累积死亡率比较差异均有统计学意义(RR=0.35,P<0.001;RR=0.32,P<0.001;RR=0.43,P<0.001);干预组与对照组在食管癌、胃癌和全恶性肿瘤的累积死亡率比较差异均有统计学意义(RR=0.70,P<0.001;RR=0.55,P<0.001;RR=0.73,P<0.001)。结论内镜筛查可有效提高上消化道癌检出率,实现癌症的早发现、早诊断和早治疗,进而降低人群上消化道癌死亡率。

OBJECTIVE The upper gastrointestinal cancer is a common malignant tumor in China.Endoscopy is an effective method to detect early cancer.The purpose of this study was to analyze the effectiveness of endoscopic screening for upper gastrointestinal cancer in reducing mortality in high-risk areas.METHODS A retrospective analysis of the incidence and death of upper gastrointestinal cancer in the 40-69 years old population in Feicheng from 2006 to 2015 was conducted.We defined those who were invited and undertook endoscopic screening as the screened group,and those who were invited but did not accept screening as non-screened group.The target subjects not covered by the screening program was assigned to the control group.The cumulative incidence and cumulative mortality of upper gastrointestinal cancer and all malignancies between the three groups were calculated and compared.RESULTS There were 42 188 target populations in the intervention group,including 23 470 in the screened group and 18 718 in the non-screened group.A total of 802 end-points events occurred,of which 339 were upper gastrointestinal cancer,accounting for 42.27%of all malignant tumor deaths.The control group had 58 106 target populations,with a total of 2 584 end-point events,including 1 194 upper gastrointestinal cancers,accounting for 46.21% of all malignant tumor deaths.The cumulative mortality of the screening group and the control group in esophageal,gastric,and total malignant tumors was different(RR=0.35,P<0.001;RR=0.32,P<0.001;RR=0.43,P<0.001).The cumulative mortality of the intervention group and the control group in esophageal,gastric,and all-malignant tumors was different(RR=0.70,P<0.001;RR=0.55,P<0.001;RR=0.73,P<0.001).CONCLUSION Endoscopic screening can effectively improve the detection rate of upper gastrointestinal cancer,achieve early detection,diagnosis and treatment of cancer,thereby reduceing the mortality of upper gastrointestinal cancer in the population.