肝癌筛查在我国人群中的可及性:一项探索性分析

Access to liver cancer screening and surveillance in populations in China:an exploratory analysis

目的系统量化肝癌筛查及监测服务在我国人群中的可及性,尤其是可获得性维度的系列指标。方法参照国际权威机构对癌症筛查可获得性评价涉及的具体内容和指标,包括当地相关政策方案、覆盖率、筛查参与率和依从率及影响因素、治疗率、接受度、公平性等,通过系统综述方法,结合核心文献/论著、官网、方案报告等渠道,对我国人群肝癌筛查及监测相关指标进行系统整合评估。结果文献检索最终纳入34篇期刊论文,多为地方性肝癌筛查参与率和监测依从率报道,更多信息来自其他渠道。分析结果提示,中央财政支持的3项癌症筛查服务项目,均在特定地区和年龄段有针对一般风险人群的肝癌筛查方案推荐及实践评价,针对筛查发现的不同高危人群有明确监测方案推荐。肝癌初筛的年度覆盖率在全国35~74岁人群中约为0.09%。因项目模式不同,整体筛查参与率(参加复筛人数÷初筛阳性人数×100%)在37.5%~62.3%之间;监测依从率(参加监测人数÷复筛阳性需监测人数×100%)在纳入6项研究的M(Q1,Q3)为26.9%(23.5%,41.0%);系统综述仅纳入2篇影响因素报道。全国大样本分析提示,城市肝癌高危人群对甲胎蛋白检测联合超声筛查的主观接受度为99.3%。农村人群筛查监测发现的肝癌患者治疗率在90%以上。未见公平性相关报道。结论我国主要公卫服务项目均有具体肝癌筛查和高危个体监测的方案推荐,但总体可获得性的提升空间大,主要体现在筛查覆盖率。筛查参与率和监测依从率均存在项目人群研究间差异,需更多影响因素探索;较高的主观接受度提示潜在的客观需求。整体而言,目前针对我国肝癌筛查监测可及性的信息仍然有限,提示需要更多关注。

Objective To systematically quantify the access to screening and surveillance service of liver cancer in populations in China,especially a series of sub-indicators of the availability.Methods Following the specific indicators applied by the International Agency for Research on Cancer in the session of availability and use of screening practices in several cancer screening handbooks,information about the access/availability of liver cancer screening and surveillance in population in China were collected;the indicators included local policies and guidelines,procedures most commonly used or recommended,population coverage and participation rate,compliance and related factors,treatment rate,acceptability,equity and others.Systematic review approach was used,combined with searching core literatures/monograph,websites of governments and available program reports,for a systematic analysis on the access to liver cancer screening and surveillance in populations in China.Results A total of 34 journal articles were included from the systematic review and most of which were about the participation of secondary liver screening or surveillance compliance;additional information were mainly obtained from the other sources.Overall,there were clearly recommended screening and surveillance procedures for liver cancer in the three major cancer screening programs funded by the central government of China.It was estimated that 0.09%of the population aged 35-74 years were covered by liver cancer screening in 2019 in China.The overall participation rates of secondary screening ranged from 37.5%to 62.3%in three major programs,the median compliance rate of surveillance was reported as 26.9%(Q1,Q3:23.5%,41.0%)in the 6 included studies.Two studies reported the factors affecting the participation and compliance.A large-scale multicenter analysis showed that the subject acceptability to alpha fetoprotein test combined with ultrasound screening was as high as 99.3%in high-risk population in urban area.The treatment rate of liver cancer founded by screening,surveillance or follow-up was estimated to be>90%in rural population.No studies of equity were obtained via the systematic review.Conclusions The public health service programs in China all recommend specific procedures for liver cancer screening in general population and surveillance for high-risk individuals.However,the overall availability needs to be improved,particularly in the indicator of population coverage.Participation rates of screening and compliance rates of surveillance varied among the included programs and the studies,suggesting that the influencing factors need to be further identified.The relatively high subject acceptability suggests the potential demands for screening service.More efforts are needed to address the access to screening and surveillance of liver cancer in populations in China.