农村上消化道癌机会性筛查分析的胃癌影响因素研究:基于苏北沿海地区

Study on the Influencing Factors of Gastric Cancer Based on Opportunistic Screening of Upper Gastrointestinal Cancer in Coastal Area of Northern Jiangsu

背景近年来,我国各省市陆续开展了上消化道癌筛查与早诊早治工作,目前苏北沿海地区有关上消化道癌筛查结果及胃癌影响因素的研究较少。目的基于苏北沿海地区农村人群上消化道癌机会性筛查结果,分析胃癌发病的影响因素,为制订相关防控策略提供参考依据。方法选取2021—2022年于徐州医科大学附属连云港医院消化内科门诊就诊并接受胃镜筛查的农村上消化道癌高危人群8564名作为调查对象。根据筛查结果按年龄(±2岁)、性别1∶2进行个体匹配,将调查对象分为胃癌组(183例)和良性胃病组(366例),收集调查对象的基线资料,并计算癌检出率和癌早诊率。采用多因素Logistic回归分析探讨苏北沿海地区农村人群胃癌发病的影响因素。结果共检出上消化道肿瘤性病变患者521例,其中胃(包括贲门)癌患者183例,检出率为2.14%(183/8564);胃(包括贲门)癌早期患者46例,早诊率为25.14%(46/183)。不同类别胃肿瘤性病变在不同性别上的分布情况比较,差异无统计学意义(P>0.05)。男性胃(包括贲门)肿瘤性病变的检出率为5.14%(195/3795),高于女性的2.05%(98/4769)(χ^(2)=60.807,P<0.001)。不同年龄组之间胃(包括贲门)肿瘤性病变检出率比较,差异有统计学意义(χ^(2)=163.216,P<0.001);不同年龄组之间胃癌早诊率比较,差异有统计学意义(χ^(2)=69.349,P<0.001),其中40~49岁组胃癌早诊率最高(37.50%),≥80岁组胃癌早诊率最低(10.53%)。多因素Logistic回归分析结果显示,初中及以下学历(OR=4.001,95%CI=2.029~7.890,P<0.001)、吸烟(OR=3.710,95%CI=2.127~6.470,P<0.001)、口味偏咸(OR=1.777,95%CI=1.067~2.957,P=0.027)、经常辛辣饮食(OR=2.147,95%CI=1.297~3.556,P=0.003)、偏食红肉(OR=1.787,95%CI=1.018~3.139,P=0.043)、经常食用剩菜(OR=2.452,95%CI=1.538~3.912,P<0.001)、不规律饮食(OR=2.420,95%CI=1.420~4.124,P=0.001)、幽门螺杆菌(H.pylori)检测阳性/既往阳性(OR=3.785,95%CI=2.394~5.984,P<0.001)为农村人群胃癌发病的危险因素,经常体育锻炼(OR=0.598,95%CI=0.359~0.996,P=0.048)和经常食用新鲜水果(OR=0.531,95%CI=0.328~0.860,P=0.010)为农村人群胃癌发病的保护因素。结论苏北沿海地区农村人群上消化道癌机会性筛查有利于上消化道癌的检出,初中及以下学历、吸烟者、多种不良饮食习惯和H.pylori阳性/既往阳性为农村人群胃癌发病的危险因素,今后应着重提高本地区农村男性、高龄群体胃癌防范意识。

Background In recent years,screening,early diagnosis and early treatment of upper gastrointestinal cancer have been successively carried out in various provinces and cities in China.At present,there are few studies on the screening results of upper gastrointestinal cancer and influencing factors of gastric cancer in coastal area of northern Jiangsu.Objective To analyze the influencing factors of gastric cancer based on the results of opportunistic screening for upper gastrointestinal cancer in rural population in coastal areas of northern Jiangsu,so as to provide a reference for the development of relevant prevention and control strategies.Methods A total of 8564 rural subjects at high risk for upper gastrointestinal cancer admitted to the outpatient department of gastroenterology of the Affiliated Lianyungang Hospital of Xuzhou Medical University and received gastroscopy screening from January 2021 to December 2022 were selected,and divided into the gastric cancer group(n=183)and benign gastric disease group(n=366)after matching according to age(±2 years)and gender(1∶2)based on the screening results.The baseline data of the subjects were collected,the cancer detection rate and cancer early diagnosis rate were calculated.Multivariate Logistic regression analysis was used to explore the influencing factors of gastric cancer in rural population in coastal area of northern Jiangsu.Results A total of 521 patients with upper gastrointestinal neoplastic lesions were detected,including 183 patients with gastric(including cardia)cancer,with a detection rate of 2.14%(183/8564);and 46 patients with early gastric(including cardia)cancer,with the early diagnosis rate of 25.14%(46/183).There was no significant difference in the distribution of different categories of gastric neoplastic lesions in different genders(P>0.05).The detection rate of gastric(including cardia)neoplastic lesions in males(5.14%,195/3795)was higher than females(2.05%,98/4769),and the difference was statistically significant(χ^(2)=60.807,P<0.001).There were significant differences in the detection rate of gastric(including cardia)neoplastic lesions among different age groups(χ^(2)=163.216,P<0.001)and early diagnosis rate of gastric cancer among different age groups(χ^(2)=69.349,P<0.001),among which the early diagnosis rate was the highest in the group of 40-49 years(37.50%)and the lowest in the group over 80 years(10.53%).Multivariate Logistic regression analysis showed that junior high school education or below(OR=4.001,95%CI=2.029-7.890,P<0.001),smoking(OR=3.710,95%CI=2.127-6.470,P<0.001),salty taste(OR=1.777,95%CI=1.067-2.957,P=0.027),frequent spicy diet(OR=2.147,95%CI=1.297-3.556,P=0.003),preference for red meat(OR=1.787,95%CI=1.018-3.139,P=0.043),frequent consumption of leftovers(OR=2.452,95%CI=1.538-3.912,P<0.001),irregular diet(OR=2.420,95%CI=1.420-4.124,P=0.001)and helicobacter pylori(H.pylori)positive/previously positive(OR=3.785,95%CI=2.394-5.984,P<0.001)were risk factors for gastric cancer in rural population,while regular physical exercise(OR=0.598,95%CI=0.359-0.996,P=0.048)and frequent consumption of fresh fruits(OR=0.531,95%CI=0.328-0.860,P=0.010)were protective factors for gastric cancer in rural population.Conclusion Opportunistic screening of upper gastrointestinal cancer is beneficial for the detection of upper gastrointestinal cancer in Coastal Area of Northern Jiangsu.Junior high school education and below,smoking,multiple unhealthy food habits and H.pylori positive/previously positive are risk factors for gastric cancer in rural population.Future efforts should focus on improving the awareness of gastric cancer prevention among rural males and elderly population in the region.