福建省柘荣县肝癌筛查及早诊早治结果分析

Screening,early diagnosis and treatment of liver cancer in Zherong county of Fujian province:2012-2019

目的 分析福建省肝癌筛查及早诊早治结果,为肝癌人群筛查效果评价提供科学基础资料。方法以福建省柘荣县为肝癌筛查现场,采用整群抽样的方法选取35~64岁男性居民和45~64岁女性居民作为研究对象。采用血清乙肝表面抗原(HBsAg)作初筛(诊断性筛查);对HBsAg阳性者每6个月联合应用血清甲胎蛋白(AFP)和肝脏B超随访复查。评估指标为任务完成率、检出率、早诊率和治疗率。对所有检出的肝癌患者开展随访,随访截止到2021年4月30日,采用寿命表法计算观察生存率。结果 2012年7月—2020年12月共完成诊断性筛查51 486人,HBsAg阳性4 412例,阳性率8.72%;阳性队列人群每6个月的随访完成10 653人次;总体任务完成率为94.16%。共检出49例肝癌病例,检出率0.32%,早诊率40.81%,治疗率79.59%。筛查队列肝癌患者的1、3、5年生存率分别为75.51%、43.28%和34.96%;2012—2014年福建省肿瘤登记地区肝癌患者则分别为36.18%、16.56%和11.60%,两组患者生存率差异均有统计学意义(均P <0.05)。结论 采用AFP联合超声的筛查方法,能检出更多肝癌患者,发现更多早期患者,提高患者生存率。应加强随访人群的依从性,提高肝癌筛查的效果。

Objective To examine outcomes of screening,early diagnosis and treatment of liver cancer in Fujian province and to provide evidences for the evaluation on population-based liver cancer screening.Methods Zherong county in a mountainous rural region of the province was selected with cluster sampling for the analysis.Serum hepatitis B virus surface antigen(HBsAg) was tested among all male residents aged 35 – 64 years and female residents aged 45 – 64 years in diagnostic screenings on liver cancer carried out from July 2012.Then serum alpha-fetoprotein(AFP) detection and B-mode ultrasonography(BU) of liver were performed in all HBsAg-positive residents every 6 months after the screening.All diagnosed liver cancer patients were followed up till April 30th,2021 and observed survival of the patients were calculated with life table method.The efficiency of the screening,early diagnosis and treatment were assessed using rate of task completion,detection,early diagnosis,and early treatment.Results Of 51 486 residents having HBsAg screening from July2012 through December 2019,4 412(8.72%) were positive.Among the HBsAg-positive participants,10 653 person-times of AFP detection and BU of liver were carried out,with an overall task completion rate of 94.16%,and totally 49 liver cancer cases were detected,with the detection rate of 0.32%.For all the diagnosed liver cancer cases,the rate of early detection was40.81% and that of early treatment was 79.59%.The calculated 1-,3-,5-year survival of the liver cancer cases were 75.51%,43.28%,and 34.96% and the survivals were significantly higher than those of 36.18%,16.56%,and 11.60% for the liver cancer patients registered from 2012 through 2014 in Fujian Provincial Cancer Registry System(P < 0.05 for all).Conclusion The study findings suggest that semiannual serum AFP detection and BU of liver could detect liver cancer cases more effectively in HBsAg-positive population and the survival of the detected liver cases may be increased due to early diagnosis and treatment.