上海某镇60岁以上农民肿瘤高危人群的特征分析

Malignant tumors in farmers over 60 years old of the high-risk population in a town in Shanghai

【目的】筛查>60岁原农村居民中恶性肿瘤和具有高危险因素的人群,以探索郊区社区肿瘤发生发展的控制情况。【方法】参考"城市癌症早诊早治项目及高危人群评估"调查表中的部分内容进行调查。临床检查包括血清肿瘤标记物检测、肺癌CT筛查,大肠癌隐血(+)+肠镜筛查,乳腺钼靶检查等。高危人群界定为上述临床检测结果阳性的对象。【结果】从14 161人中筛查出肿瘤高危对象271人,占1.91%;其中发现恶性肿瘤71例,占高危对象的26.19%,发病率为501.38/10万,早期病例占15.46%。前5位肿瘤占所有确诊的63.38%,主要集中肺、上消化道、血液系统、泌尿系统、直-结肠等部位。阳性指标检出恶性肿瘤的比例:血液为61.54%,癌胚抗原、糖类抗原125(CEA/CA125)为46.15%,甲胎蛋白为23.08%,肺CT为16.66%,前列腺特异性抗原(PSA)为3.09%。高危对象的主要阳性指标集中在前列腺、肺部、肝、CEA/CA125等检查指标。检测指标阳性的对象和指标正常的对象比较发现,最近5年平均年收入低于正常组(χ^(2)=3.380,P=0.040),差异有统计学意义;肿瘤家族史高于正常组,差异有统计学意义(χ^(2)=2.596,P=0.046)。高危组人群患高血压、肝病、胃肠道疾病、呼吸系统疾病、手术治疗的比例高于正常人群组,差异有统计学意义(P<0.05);最近1年内发现肿瘤高危对象出现肿瘤前期临床症状的比例均高于正常组人群,差异有统计学意义(P<0.05)。调查2组人群的肿瘤相关危险因素,发现高危组的高脂高胆固醇饮食、饮酒、被动吸烟、性格压抑的比例高于正常组,差异有统计学意义(P<0.05)。【结论】该人群具有较高的肿瘤危险因素,今后需要加强危险因素的干预和癌前疾病的治疗随访。建议政府在高危人群中进行肿瘤筛查,以提高成本效益。

[Objective]To screen for malignant tumors and high-risk factors in rural residents over 60 years old,so as to prevent and control the occurrence and development of tumors in the future.[Methods]The survey was conducted with reference to part of the questionnaire in the "Urban Cancer Early Diagnosis and Treatment Project and Evaluation of High-risk Populations". Clinical examinations included serum tumor marker detection,CT screening for lung cancer,occult blood(+)plus colonoscopy screening for colorectal cancer,and mammography screening. Individuals who were positive in the abovementioned clinical tests were defined as high-risk subjects.[Results]A total of 271 highrisk subjects(1.91%)were screened out of 14 161. Among the high-risk subjects,71 cases of malignant tumors(26.19%)were found,with an incidence rate of 501.38 per 10;. The top five tumors(63.38% of all diagnosed)were mainly concentrated in lung,upper digestive tract,blood system,urinary system,and rectum-colon. The proportion of malignant tumors detected by positive indicators was 61.54% of blood;46.15% of carcinoembryonic antigen and carbohydrate antigen 125;23.08% of alpha-fetoprotein;16.66% of lung CT;and 3.09% of prostate PSA. The positive indicators in the high-risk subjects were mainly for the tumors in the prostate,lungs,liver,and CEA/CA125. The subjects with positive test indicators had lower average annual income in the last 5 years than the normal subject group(χ^(2)=3.380,P=0.040). The subjects with positive test indicators had higher proportion in family history of tumors than the normal group(χ^(2)=2.596,P=0.046). People in the high-risk group had a higher proportion than the normal group in suffering from hypertension,liver disease,gastrointestinal disease,respiratory system disease,and surgical treatment. Patients with high-risk tumors were found to have higher proportion than the normal group in showing pre-tumor clinical symptoms in the last 1 year. Study of the tumor-related risk factors found that the high-risk group had a higher proportion of high-fat/high-cholesterol diet,alcohol drinking,passive smoking,and personality depression.[Conclusion]High tumor risk factors have been identified in this population. It is necessary to strengthen the corresponding intervention and follow-up treatment of precancerous diseases in the future. We recommend the government to conduct tumor screening among high-risk groups to improve cost-effectiveness.