Trends in high-risk rates and screening rates for the population-based cancer screening program on esophageal,stomach and liver cancer in China,2010-2016

Background:A population-based cancer screening program in rural China,targeting three types of cancer that are most prevalent in these areas,including esophageal,stomach,and liver cancer was awarded by the government in China since 2007.A two-step design with cancer risk assessment based on questionnaire interview and HBsAg test strip and subsequent clinical intervention for high-risk populations was adopted with free of charge at the local hospitals designated in the program.The participate rate including high-risk rates and screening rates was important to find appropriate strategies to improve the overall awareness of the program.Methods:Data from the cancer screening program between 2010 and 2016 were used to calculate higher rate(high-risk population/participants recruited)and screening rate(participants received screening/high-risk pop-ulation).Results:From 2010 to 2016,1,637,429 residents were recruited in the program and filled the questionnaires,350,646(21.4%)for esophagus cancer,273,715(16.7%)for stomach cancer and 1,013,068(61.9%)for liver can-cer.471,974 participants were assessed as high-risk population including 114,786(24.3%)high risk for esophagus cancer,161,809(34.3%)high risk for stomach cancer and 195,379(41.4%)high risk for liver cancer,respec-tively.249,185(52.8%)participants who were assessed as high risk received clinical screening.There were 64,710(26.0%)for esophagus cancer screening,71,365(28.6%)for stomach cancer screening and 113,110(45.4%)for liver cancer screening,respectively.Conclusion:Our findings will provide important references for designing effective population-based screening strategies to enhance the screening acceptance by health action plan in the future.

Age scope of high-risk population for esophageal cancer in Ci county

AIM: To define the age scope of high-risk population for esophageal cancer (EC) in Ci county. METHODS: The results of endoscopic examination of 2 013 subjects, cytological screening of 16 763 persons and records of 9 265 patients with EC were analyzed by Ridit methods, the standard age group was 45-49 year group. RESULTS: The average age of patients with moderate esophageal epithelium dysplasia by endoscopic examination was 53.5 years, of severe esophageal epithelium dysplasia, 51.4 years, early EC, 55.6 years. The average age of stage one severe epithelium dysplasia (SEEDⅠ) by cytological screening was 51.2 years, of stage two severe epithelium esophageal dysplasia (SEED Ⅱ) 51.6 years, of advanced EC 61.7 years. In the group of 40-year olds, the value of Ridit by pathological diagnosis was 0.46, 95% CI, 0.45-0.47, that by cytological diagnosis was 0.45, 95% CI, 0.43-0.47. As the age increased at five-year intervals, the value of Ridit increased significantly. CONCLUSION: In Ci county of a high incidence area of EC, the age definition of high-risk population should be above 45 years.

Living with liver disease in the era of COVID-19-the impact of the epidemic and the threat to high-risk populations

The cardinal symptoms of severe acute respiratory syndrome coronavirus 2 infection as the pandemic began in 2020 were cough,fever,and dyspnea,thus characterizing the virus as a predominantly pulmonary disease.While it is apparent that many patients presenting acutely to the hospital with coronavirus disease 2019(COVID-19)infection have complaints of respiratory symptoms,other vital organs and systems are also being affected.In fact,almost half of COVID-19 hospitalized patients were found to have evidence of some degree of liver injury.Incidence and severity of liver injury in patients with underlying liver disease were even greater.According to the Centers of Disease Control and Prevention,from August 1,2020 to May 31,2022 there have been a total of 4745738 COVID-19 hospital admissions.Considering the gravity of the COVID-19 pandemic and the incidence of liver injury in COVID-19 patients,it is imperative that we as clinicians understand the effects of the virus on the liver and conversely,the effect of underlying hepatobiliary conditions on the severity of the viral course itself.In this article,we review the spectrum of novel studies regarding COVID-19 induced liver injury,compiling data on the effects of the virus in various age and high-risk groups,especially those with preexisting liver disease,in order to obtain a comprehensive understanding of this disease process.We also provide an update of the impact of the new Omicron variant and the changing nature of COVID-19 pathogenesis.

Heterogeneity beyond tumor heterogeneity—SULF2 involvement in Wnt/β-catenin signaling activation in a heterogeneous side population of liver cancer cells

Introduction:Sulfatase 2(SULF2),an endogenous extracellular sulfatase,can remove 6-O-sulfate groups of glucosamine residues from heparan sulfate(HS)chains to modulate the Wnt/β-catenin signaling pathway,which plays an important role in both liver carcinogenesis and embryogenesis.Side population(SP)cells are widely identified as stem-like cancer cells and are closely related to carcinoma metastasis,recurrence,and poor patient prognosis.However,the roles of SULF2 in SP cells of hepatomas are unclear,and the underlying mechanism is undefined.Objectives:This study aimed to compare the heterogeneity between SP cells and non-side population(NSP)cells derived from three different liver cancer cell lines and to elucidate the involvement of the SULF2-Wnt/β-catenin axis in liver cancer stem cells(CSCs)and its impact on the processes of carcinogenesis and invasiveness.Methods:In this work,three different liver cancer SP cells(HepG2,Huh7,and PRC/PRL/5)were sorted by flow cytometry.We also examined the migration and invasion behaviors of SP and NSP cells.To determine if this high tumorigenic potential of SP cells is correlated to SULF2,qPCR,western blotting,and immunofluorescence analysis were conducted.We also performed nude mouse xenograft experiments for in vivo analysis.Results:The results from the in vitro colony formation assay showed that SP cells exhibited a 2-fold higher colony formation efficiency compared to their NSP counterparts.The SP cells exhibited significantly higher potentials in terms of their migratory capacity and invasive ability compared to NSP cells.We found that higher expression of SULF2 in SP cells was associated with greater capabilities for clonogenicity,migration,and invasion.It was also linked to higher activation of the Wnt/β-catenin signaling pathway via stimulation of key downstream factors,particularlyβ-catenin,c-Myc,and cyclin D1.Further,a positive correlation between the upregulated SULF2 expression and tumorigenesis in the in vivo nude mouse xenograft models was demonstrated,highlighting that the potential underlying mechanism was Wnt/β-catenin signaling pathway activation.Conclusion:Our findings show that variable SULF2 expression was associated with differential activation of the Wnt/β-catenin signaling pathway,which could lead to behavioral differences between SP and NSP cells and also among the SP cells of the three liver cancer cell lines assessed.It was reasonably concluded that the SULF2-Wnt/β-catenin axis could play an important role in the tumorigenicity of liver cancer stem cells.

Attributable deaths of liver cancer in China

Objective:There is little information about contributions of the well-known risk factors to the liver cancer burden.We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors.Methods:Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in2014.Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International.Population attributable fraction(PAF)by age,sex,and province was calculated using multiple formulas.Results:In total,72.4%of liver cancer deaths could be attributable to the studied risk factors.Hepatitis B virus(HBV)was responsible for the largest fraction of liver cancer burden in both genders(PAF=55.6%in males,PAF=46.5%in females).PAFs for liver cancer burden attributable to smoking(15.7%vs.4.8%),and alcohol drinking(10.3%vs.1.6%)were significantly higher in males than in females.The burden of HBV-attributable deaths was the highest in Qinghai province.Conclusions:HBV still contributes to the majority of liver cancer burden than any other risk factors.Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.

Development and validation of a prediction model for early screening of people at high risk for colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.

原发性肝癌的流行病学及其危险因素研究进展

原发性肝癌是世界上常见的恶性肿瘤之一,具有较高的发病率和死亡率。本文详述了目前我国原发性肝癌的流行病学情况、人群归因分值及其相关危险因素。本文通过检索PubMed、Web of Science、中国知网等数据库发现,乙型肝炎病毒和丙型肝炎病毒仍是原发性肝癌发病的主要危险因素。随着乙型肝炎病毒疫苗接种以及抗病毒治疗,我国原发性肝癌的发病率略有下降,但代谢性因素如糖尿病、肥胖和非酒精性脂肪性肝病等引起的原发性肝癌的发病率正逐步上升;吸烟、饮酒等也是重要的危险因素。本文综述了原发性肝癌的流行病学特点及危险因素,可为制订原发性肝癌防控措施提供切实有力的循证医学证据。

原发性肝癌高危人群的研究

本文通过分析上海市肝癌发病情况和上海医科大学肝癌研究所的肝癌住院病人，显示上海市肝癌男性标化发病率为２９．６／１０万，女性为１０．０／１０万，男女合计为２０．１／１０万。男女发病率比约为３：１．男性肝癌发病率在３５岁前较低。以后逐渐上升，至４０岁接近男性全市平均水平，５０岁后发病率增幅较前要快，至８０岁达到高峰。女性肝癌发病率较男性低，年龄亦较晚，到５０岁才接近女性全市平均水平，发病年龄的高峰与男性相差１０年左右。肝癌患者中ＨＢｓＡｇ的阳性率显著高于自然人群，在有慢性肝炎史的肝癌患者中有近１／４的人ＨＢｓＡｇ阴性，提示有丙肝病毒感染的可能，肝癌患者的抗－ＨＣＶ阳性率为１１．１％，与ＨＢｓＡｇ的双重阳性率为５．８％，提示与ＨＢｓＡｇ独立，而在人群中抗ＨＣＶ的阳性率为２％左右，提示ＨＣＶ也是原发性肝癌的危险因素，所以肝癌的高危人群应包括抗ＨＣＶ阳性及一切有慢性病毒性肝炎史者。本文认为，在上海市，男性４５岁以上，女性５０岁以上，ＨＢｓＡｇ阳性或抗ＨＣＶ阳性或有慢性肝炎史的人群是肝癌的高危人群。

广西肝癌高危人群队列和高发家系样本数据库的建立

目的建立肝癌高危人群队列和高发家系的血样本库和基础资料数据库。方法在广西肝癌高发现场,选择肝癌高发年龄段常住居民进行防癌筛查和流行病学调查,其中HBsAg阳性的对象列为肝癌高危人群队列,对其定期随访和复查;根据基于人群的肿瘤登记资料和临床流行病学资料,选取肝癌高发家系并匹配相应对照家系。对所有研究对象均采集早晨空腹静脉血,进行HBsAg等生化指标检测和腹部B超检查;分离其血清、血浆和有核细胞,置于-80℃保存。所有资料按要求进行质控,并录入数据库。结果已收集了30 000多人次的血清、血浆和有核细胞及其基础资料,并妥善保存和实行计算机动态管理。结论建立该样本数据库,为下一步开展更深层次、高水平和高质量的广西区域性高发肿瘤基础研究、现场防控与临床研究,搭建了资源共享平台;探索和建立了一个具有先进性、科学性以及通用性等优点的数据管理系统,逐步实现了样本和资料的科学有效管理。

肝癌干细胞与肝癌的研究进展

肿瘤起源于干细胞的假说已在人类许多实体瘤中得到证实,近来亦发现肝癌中存在肝癌干细胞。肿瘤干细胞被认为是肿瘤产生的根源,对肿瘤的发生、发展、转移、复发及耐药具有关键作用。因此,如何分离鉴定肝癌干细胞对于改善预防方法、促进早期检测以及研发新的治疗方法都是一个非常紧迫的课题。本文就肝癌干细胞的来源、表面标志、分选方法、应用前景及存在的问题作一综述。

在高危人群中普查随访发现的肝癌临床研究

本文报告从１９８５年１月到１９９１年６月在高危人群中通过群众普查和肝病随访发现的肝癌１０２例，６３例（６１．６％）病理证实为肝细胞癌，２１例（２０．６％）ＡＦＰ＜５０μｇ／Ｌ肝癌依赖Ｂ超发现，１０例（９．８％）ＡＦＰ５０－４００μｇ／Ｌ肝癌依赖ＡＦＰ与Ｂ超获得诊断。１０２例肝癌中７９．４％为亚临床癌，通过手术，Ｂ超、ＣＴ和肝动脉造影证实肿癌５４例（５２．９％）。手术切除率为７３．５％（２５／３４）

2002～2005年上海市社区肝癌高危人群筛检成本效果分析

[目的]评估2002～2005年上海市社区肝癌高危人群筛检的效果，从卫生经济学方面探讨经济有效的筛检方法。[方法]对上海市健康档案和医院门诊对象中符合肝癌高危人群标准并愿意参加的3280例对象进行“AFP＋B超”筛检。运用项目成本测算方法计算筛检的成本，以发生肝癌例数和早中期肝癌例数作为效果指标进行成本效果分析。[结果]社区肝癌高危人群筛检的总成本为4025544．00元。高危人群的随访筛检次均成本为411，80元。去除间接成本部分，次均直接成本为21．80元，次均自付直接成本为15．00元。发现1例肝癌和早中期（I期和Ⅱ期）肝癌患者的总成本分别为575077，71元和1006386，00元。[结论]以10万人社区为假设，每人每年增加0．24元专项肿瘤筛查经费就能有效地发现早中期肝癌患者。

肝癌高发区高危人群HBsAg阴转随访观察

目的 :了解广西肝癌高发区高危人群 HBs Ag阴转情况。方法 :在广西肝癌高发区筛查高危人群 ,采用放射免疫法 (RIA)检测血清 HBs Ag,2年后随访复查。结果 :肝癌高危人群 HBs Ag年阴转率为 3.0 % ,在该人群中 HBs Ag年阴转率的年龄分布为低年龄组 (2 5～ 2 9岁 )和高年龄组 (5 0～ 5 4岁 )较高 ,中间各年龄组较低 ,除了 4 0岁组与 5 0岁组之间差异有统计学意义外(χ2 =3.87,P <0 .0 5 ) ,各年龄组之间差异无统计学意义。结论 :肝癌高危人群 HBs Ag阴转率不高 ,该人群 HBs

高发区肝癌的二级预防研究

本文报告启东肝癌高发区在肝癌人群筛检方面的主要研究结果，并就筛检问题及前景作简要的阐述。把ＨＢｓＡｇ阳性的３０～５９岁的男性定义为肝癌的高危险人群，并进行了有随机对照的周期性的筛检。结果表明，对该人群采用每隔６个月一次的筛检策略，可使肝癌的年均发现率达到１５９９．３８／１０万，约为自然人群发生率的３０倍；筛检病例中Ⅰ期肝癌的比重可达到８６．６７％；筛检组与对照组的生存曲线经Ｌｏｇｒａｎｋ检验，差异非常显著。继续实施、完善人群筛检研究，是现场二级预防面临的主要任务。

侧群细胞与肝癌干细胞

肝癌是严重威胁人类生命和健康的一种疾病.其病因和发病机制尚不完全清楚,治疗缺少有效靶点.对肝癌恶性生长、转移及复发机制的研究正在逐渐深入.近年来的研究认为,肿瘤中存在一小群具有自我更新和分化潜能的细胞,即肿瘤干细胞,可能是肿瘤转移和复发的根源.肝癌中应同样存在这样的一群细胞.侧群(sidepopulation,SP)细胞是肿瘤细胞中一小部分,具备干细胞的多种特性且易于分离.肝癌组织中SP细胞的鉴定和分离有可能找到肝癌干细胞,有助于肝癌的转移和复发机制的研究,并为肝癌治疗提供有效治疗靶点.

广西区原发性肝癌高危人群中NF-κB信号传导通路基因多态性的研究

目的:探讨NF-κB信号传导通路基因多态性与肝癌发生、发展的关系。方法:在广西区原发性肝癌高发地区随机抽取并筛查550名实验对象,均为乙肝病毒携带者,实验中使用DNA抽提试剂盒提取出各实验对象多核细胞中的基因组DNA;利用限制性片段长度多态性检测法检测肝癌高危人群NF-κB信号传导通路的基因多态性。结果:该组肝癌高危人群中,各基因多态性类型出现的频率在男女不同性别分组中趋势基本一致,无统计学意义;其中TNF-oα-308(G/A)、NF-κB-94(ins/del ATTG)位点的变异等位基因出现频率高于已有中国普通人群报道的检测结果。结论:NF-κB信号传导通路基因多态性与该地区肝癌的发生、发展有着相关关系。

新疆地区胃癌肝转移患者98例临床病理资料分析

目的分析新疆胃癌肝转移患者临床病理资料特点,为新疆胃癌肝转移患者的个体化治疗提供参考。方法收集我院2010年1月～2012年1月收治的胃癌肝转移患者资料,其中汉族52例,少数民族36例,按患者年龄、性别、肿瘤部位、分化程度、T、N、肝外转移及肝转移情况进行比较分析。结果与汉族患者相比,少数民族患者中淋巴结转移者常见(P<0.05);肝转移最大径>5cm多见(P<0.05);患者的年龄、性别、肿瘤部位、分化程度、T、肝外转移、肝转移程度、民族间无明显差异(P>0.05)。结论胃癌肝转移预后指标提示少数民族预后可能较汉族差。

肝癌干细胞的研究进展

肿瘤干细胞已经被证实存在于一些肿瘤组织中,而肝癌干细胞是否存在仍未得到确切的结果.通过实验,研究人员对于肝癌干细胞的来源提出了两个假说:成熟肝细胞的去分化与肝干细胞的"成熟受阻".目前后者是较为公认的肝癌形成途径.同时,为了得到肝癌干细胞存在的直接证据,研究人员一直致力于其表面标志物的研究,希望通过得到理想的标志物来鉴定分选出肝癌干细胞.SP细胞与肝癌干细胞的研究也是目前研究的热点.因此,肝癌干细胞的研究将会对肝癌的诊断和治疗产生重大的意义.

多项肿瘤标志物联合应用对肝癌的诊断价值

目的探讨甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)、癌胚抗原(CEA)和糖链抗原19-9(CA19-9)四种肿瘤标志物对肝癌的诊断价值。方法收集70例肝癌患者(肝癌组)、80例慢性肝病患者(慢性肝病组)和80例健康体检者(对照组)的临床资料,比较3组研究对象的血清AFP、AFU、CEA和CA19-9水平及其阳性率,比较原发性肝癌与转移性肝癌患者的血清AFP、AFU、CEA和CA19-9水平,分析多指标联合应用对乙肝表面抗原(HBs Ag)(+)肝癌与HBs Ag(-)肝癌患者的诊断价值。结果肝癌组患者的血清AFP、AFU、CEA、CA19-9水平及阳性率均高于对照组和慢性肝病组(P﹤0.05)。原发性肝癌患者的血清AFP和AFU水平明显高于转移性肝癌患者(P﹤0.01),血清CEA水平明显低于转移性肝癌患者(P﹤0.01)。不同的筛查组合对HBs Ag(+)肝癌患者的诊断灵敏度均高于HBs Ag(-)肝癌患者,其中AFP+AFU+CEA筛查对HBs Ag(+)肝癌患者的灵敏度和约登指数最高,分别为91.11%和0.80。结论应用AFP+AFU+CEA进行肝癌筛查的诊断效率较好,适合作为HBs Ag(+)肝癌高危人群的筛查项目,且有助于区别原发性肝癌和转移性肝癌。

基于隐结构模型的原发性肝癌不同症状群预后差异性分析

目的基于隐结构模型建立原发性肝癌(Primary liver cancer,PLC)症状人群的分类方法,探究PLC不同症状群的生存预后差异性。方法利用人机协同表型谱标注系统(www.tcmai.org),对565例西医诊断为PLC的结构化中医电子病历文本进行实体标注,建立症状数据库并进行规范化处理,运用Lantern 5.0软件构建PLC的中医症状隐结构模型,结合中医专业理论知识基础,对分类结果进行模型学习诠释,归纳出有临床意义的症状人群分类,分析PLC特征性症状占比进行症状群-人群匹配,结合患者住院时长及生存信息,分析PLC不同症状群人群的预后差异。结果共纳入131个中医症状(即显变量)构建PLC症状隐结构模型,获得14个隐变量,通过综合聚类归纳出10个症状群,具体表现为精神状态相关症状群、消化系统相关症状群、癌性疲乏相关症状群、呼吸循环相关症状群和其他一般症状群5大类。其中癌性疲乏症状群和黄疸类症状群的预后具有显著差异性。结论通过建立隐结构模型挖掘PLC症状群,划分人群的研究方法,证实了PLC不同症状群存在预后差异性,为症状群分类及人群划分研究提供了一个新的思路。