Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China

AIM:To estimate the cost-benefit of endoscopic screening strategies of esophageal cancer(EC)in high-risk areas of China. METHODS:Markov model-based analyses were conducted to compare the net present values(NPVs)and the benefit-cost ratios(BCRs)of 12 EC endoscopic screening strategies.Strategies varied according to the targeted screening age,screening frequencies,and follow-up intervals.Model parameters were collected from population-based studies in China,published literatures,and surveillance data. RESULTS:Compared with non-screening outcomes,all strategies with hypothetical 100 000 subjects saved life years.Among five dominant strategies determined by the incremental cost-effectiveness analysis,screening once at age 50 years incurred the lowest NPV(international dollar-I$55 million)and BCR(2.52).Screening six times between 40-70 years at a 5-year interval[i.e., six times(40)f-strategy]yielded the highest NPV(I$99 million)and BCR(3.06).Compared with six times(40)fstrategy,screening thrice between 40-70 years at a 10-year interval resulted in relatively lower NPV,but the same BCR. CONCLUSION:EC endoscopic screening is cost-beneficial in high-risk areas of China.Policy-makers should consider the cost-benefit,population acceptance,and local economic status when choosing suitable screening strategies.

Reflections on the New Classification of Tumors by the WHO and Changes in Esophageal Cancer in a High-risk Area

ABSTRACT In year 2000, a book entitled the Pathology and Genetics of Tumors of the Digestive System was published by the WHO, presenting some new diagnostic criteria and treatment principles. I have analyzed the epidemiologic change of tumors in over 30 years in the high-risk area with esophageal cancer. The following phenomenon was found： accompanied by the sharp decrease in the incidence and mortality of esophageal cancer, there was an increase in the incidence and death rate of stomach cancer involving cardiac cancer. This fact should be considered when analyzing the sharp decrease in esophageal cancer incidence and mortality rate. More attention was given to diagnosis of cardiac cancer; at the same time it is more practical to improve the early screening of cancers. To observe the development of high and low - grade intraepithelial neoplasms will be an urgent task for esophageal cancer research in the high risk area, according to WHO＇s new classification.

Gastric cancer incidence and mortality in Zhuanghe,China,between 2005 and 2010

AIM： To investigate the incidence and mortality of gastric cancer （GC） in Zhuanghe region, northeast China and the influencing factors for their changing trends.METHODS： All new cancer cases and deaths registered from 2005 to 2010 in Zhuanghe County were reviewed. The annual GC cases, constituent ratio, crude rates,age-standardized rates, their sex and age distribution and temporal trends were assessed. The method of annual percentage change （APC） was used to estimate the trends of GC.RESULTS： Altogether 2634 new cases of GC and 1722 related deaths were registered, which accounted for 21.04% and 19.13% of all cancer-related incidence and deaths, respectively. The age-standardized incidence rate steadily decreased from 57.48 in 2005 to 44.53 in 2010 per 10^5 males, and from 18.13 to 14.70 per 10s females, resulting in a APC of -5.81% for males and -2.89% for females over the entire period. The magnitude of APC in GC mortality amounted to -11.09% and -15.23%, respectively, as the agestandardized mortality rate steadily decreased from 42.08 in 2005 to 23.71 in 2010 per 10^5 males, and from 23.86 to 10.78 per 10^5 females. Females had a significantly lower incidence （a male/female ratio 2.80, P 〈 0.001） and mortality （a male/female ratio 2.30, P 〈 0.001）. In both genders, the peak incidence and mortality occurred in the 80-84 years age group. The age-standardized mortality/incidence ratio also decreased from the peak of 0.73 in 2005 to 0.53 in 2010 for males, and from 1.32 to 0.73 for females.CONCLUSION： Encouraging declines of incidence and mortality of GC were observed in Zhuanghe region between 2005 and 2010, possibly due to the economic development and efficient GC control strategies.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background： Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods： Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group （0, 1-4, 5-9, 10-14...80＋）. Incidence and mortality rates were age-standardized to World Segi＇s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results： The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 （males, 42.18/100,000 and females, 24.31/100,000）. The age-standardized rate by world standard population （ASRW） was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 （males, 31.40/100,000 and females, 18.45/100,000）, ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 （ASRW =48.69/100,000） to 2004-2005 （ASRW =28.02/100,000）, with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes （APC） of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Conclusions： Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

Can Stomach Cancer be Prevented by Dietary Change: Preliminary Summary of Comparative Etiologic Study and Prevention

During 1984 to 1990, a comparative etiologic studyand primary prevention for stomach cancer was carriedout in a high risk area in Zhuanghe County of LiaoningProvince. Because of the increase of consumption of fr-esh vegetables and fruits (Protective factors), decreaseof eating salted pork and fishes which was verified tohave strong mutagenecity (risk factors), acute inflamma-tion and erosions accompanying with chronic gastritis havegot striking improvement. At the same time, serum betac-arotene also raised gradually. The authors stressed thatimprovement of economic situation and dietary habits mayplay an important role in primary prevention of precurso-res of stomach cancer but decrease of incidence of thiscancer is an event of 30 years or more later as the letentperiod of stomach cancer is rather long.

中国胃癌高发现场研究进展

中国是胃癌高发国家,胃癌发病存在鲜明的地域特性,高发区大多处于经济相对欠发达的农业地区,这一独特性为胃癌研究提供了宝贵的现场条件与资源优势。自20世纪80年代以来,我国研究者基于胃癌高发现场动态观察和认识胃癌发病的自然史,探讨影响胃癌发生的相关因素,开展胃癌一级预防有效性和可行性研究,并进行大规模人群筛查项目,对阐明胃癌流行病学和病因学因素及胃癌防控策略的制定与优化提供了重要科学依据。本文针对中国胃癌高发区防治现场的研究进展作一综述,旨在全面梳理和解读我国基于高发区开展胃癌预防的历史、现状、成效与挑战,以期为提升胃癌防控能力、降低胃癌发病率和死亡率提供科学依据和实践指导。

Associations between cancer family history and esophageal cancer and precancerous lesions in high-risk areas of China

Background:Family clustering of esophageal cancer(EC)has been found in high-risk areas of China.However,the relationships between cancer family history and esophageal cancer and precancerous lesions(ECPL)have not been comprehensively reported in recent years.This study aimed to provide evidence for identification of high-risk populations.Methods:This study was conducted in five high-risk areas in China from 2017 to 2019,based on the National Cohort of Esophageal Cancer.The permanent residents aged 40 to 69 years were examined by endoscopy,and pathological examination was performed for suspicious lesions.Information on demographic characteristics,environmental factors,and cancer family history was collected.Unconditional logistic regression was applied to evaluate odds ratios between family history related factors and ECPL.Results:Among 33,008 participants,6143(18.61%)reported positive family history of EC.The proportion of positive family history varied significantly among high-risk areas.After adjusting for risk factors,participants with a family history of positive cancer,gastric and esophageal cancer or EC had 1.49-fold(95%confidence interval[CI]:1.36-1.62),1.52-fold(95%CI:1.38-1.67),or 1.66-fold(95%CI:1.50-1.84)higher risks of ECPL,respectively.Participants with single or multiple first-degree relatives(FDR)of positive EC history had 1.65-fold(95%CI:1.47-1.84)or 1.93-fold(95%CI:1.46-2.54)higher risks of ECPL.Participants with FDRs who developed EC before 35,45,and 50 years of age had 4.05-fold(95%CI:1.30-12.65),2.11-fold(95%CI:1.37-3.25),and 1.91-fold(95%CI:1.44-2.54)higher risks of ECPL,respectively.Conclusions:Participants with positive family history of EC had significantly higher risk of ECPL.This risk increased with the number of EC positive FDRs and EC family history of early onset.Distinctive genetic risk factors of the population in high-risk areas of China require further investigation.Trial registration:ChiCTR-EOC-17010553.

血清CEA、TK1、CA724、PGⅠ/PGⅡ联合检验在早期胃癌中的诊断效能

目的 分析血清癌胚抗原(CEA)、胸苷激酶(TK1)、糖类抗原(CA)724、胃蛋白酶原I(PGI)/PGⅡ联合检测诊断早期胃癌的效果。方法 将2021年8月-2022年8月本院收治的89例早期胃癌患者纳入观察组;另将同期本院收治的90例胃良性病变患者纳入对照组;并将同期于本院行健康体检的85例健康人群纳入健康组,采集三组静脉血,检测对比其血清CEA、TK1、CA724、PGⅠ/PGⅡ的差异;另绘制受试者工作曲线(ROC),分析CEA、TK1、CA724、PGⅠ/PGⅡ联合检测诊断早期胃癌的效能。结果 观察组CEA为(19.84±2.23)ng/m L、TK1为(3.97±0.52)pmol/L、CA724为(42.89±5.31)U/m L,高于对照组的(2.57±0.26)ng/m L、(1.18±0.23)pmol/L、(4.15±0.57)U/m L与健康组的(2.36±0.35)ng/m L、(1.16±0.27)pmol/L、(3.87±0.46)U/m L,PGⅠ/PGⅡ为(2.31±0.26),低于对照组的(4.89±0.75)与健康组的(5.31±0.96),差异有统计学意义(P<0.05);ROC结果显示:CEA、TK1、CA724、PGⅠ/PGⅡ联合检测诊断早期胃癌的曲线下面积(AUC)为0.947(95%CI:0.910-0.984),高于几者单独检测的0.846(95%CI:0.787-0.904)、0.862(95%CI:0.801-0.922)、0.867(95%CI:0.814-0.919)、0.873(95%CI:0.819-0.928)。结论 早期胃癌患者机体内的CEA、TK1、CA724呈异常高表达,PGⅠ/PGⅡ呈异常低表达,四者联合可有效提高早期胃癌的诊断准确度,为临床提供可靠的依据,临床应用价值较高,值得大力推行。

远端胃癌D_2根治术中常规胃裸区清扫的临床价值探讨

目的探讨远端胃癌根治术中行胃裸区清扫的临床效果及价值。方法将同期收治的50例远端胃癌(T1～3N0～2M0)患者随机分为观察组和对照组,各25例。两组均行D2根治术;观察组术中行胃裸区常规清扫。观察两组总有效率、围术期并发症及不良反应发生率;随访5 a,观察术后5年生存率、肿瘤术后复发率及转移率及患者生存质量(Spitzer评分)。结果观察组总有效率明显高于对照组(P<0.05),两组围术期并发症及不良反应发生率无明显差异;观察组术后5年生存率、Spitzer评分明显高于对照组,肿瘤复发率及转移率明显低于对照组,P均<0.05。结论胃远端胃癌D2根治术中常规行胃裸区清扫可提高患者5年生存率,明显改善预后。

胃癌高发区幽门螺杆菌感染与胃黏膜肠化生关系的研究

目的:探讨陕北胃癌高发区幽门螺杆菌(HP)感染与胃黏膜肠化生之间的关系。方法:收集两次普查中行胃镜检查的病例共487例,把慢性胃炎病例(479例)分为无肠化生及轻、中、重度肠化生4组,检测、比较各组之间HP的感染率。结果:无肠化生及轻、中、重度肠化生组HP感染率分别为55.87%、80.52%、76.56%、67.74%。轻、中度肠化生组HP感染率明显高于无肠化生组(P值均<0.05)。其余各组之间HP感染率比较无显著性差异(P值均>0.05)。结论:陕北胃癌高发区轻、中度肠化生与HP感染密切相关。

甘肃武威地区农村出院胃癌患者生命质量及其影响因素研究

目的了解胃癌高发区农村出院胃癌患者生命质量的总体情况并分析其影响因素,为提高和改善胃癌患者生命质量提供依据。方法选取甘肃省武威地区作为研究现场,采用现况调查的方法,利用欧洲癌症研究与治疗组织(EuropeanOrganization for Research and Treatment Cancer,EORTC)(QLQ-C30 3.0)生命质量问卷(中文版)和胃癌患者生命质量特异性问卷(QLQ-STO22)(中文版)对随机抽取的135名农村地区胃癌患者进行入户随访调查,同时了解患者的一般情况。结果农村地区胃癌患者生命质量总体状况得分为56.17±20.23。单因素分析结果显示:性别、婚姻状况、教育水平、职业、家庭年收入、肿瘤分化程度、对医疗服务和费用的满意程度是农村胃癌患者生命质量总体状况得分的影响因素;生命质量总体状况得分多重回归分析显示男性患者生命质量好于女性患者,家庭年收入、教育水平和对医疗费用的满意程度越高,患者生命质量总体状况越好。结论农村胃癌患者生命质量总体情况有待改善。针对农村地区胃癌患者生命质量的影响因素采取相应措施,有助于提高和改善胃癌患者的生命质量。

我国南北两地同期食管贲门癌患者的临床特征分析

目的了解食管贲门癌在我国高、低发病区的发病特征。方法对比分析海南省农垦总医院和河南科技大学第一附属医院11年间(1996年至2006年)收治的食管贲门癌患者的例数、年龄和性别分布特征及规律。结果 11年间海南省农垦总医院收治食管癌和贲门癌为523例,占全部恶性肿瘤的8.0%,其中食管癌419例(80.1%),明显高于贲门癌104例(19.9%);河南科技大学第一附属医院同期收治食管癌和贲门癌为5378例,占全部恶性肿瘤的30.4%,其中食管癌4088例(76.0%),明显高于贲门癌1290例(24.0%)。海南地区食管癌男女构成比为4.7∶1,贲门癌为4∶1;洛阳地区食管癌男女构成比为1.7∶1,贲门癌为3.8∶1。结论 11年来食管贲门癌的发病率排名在我国两地区全部恶性肿瘤中无太大变化。不论在我国高、低发病区食管癌的发病率均明显高于贲门癌;男性明显多于女性,尤其是在低发病区。

太行山食管癌高发区10561例食管/贲门癌患者ABO血型分布特征及体重指数

目的:探讨太行山食管癌高发区食管/贲门癌患者ABO血型分布特征及体重指数与食管/贲门癌关系。方法:对太行山食管癌高发区多家医院病例进行回顾性调查,收集10 561例食管/贲门癌患者年龄、性别、籍贯、ABO血型及身高、体重等资料,计算体重指数(BM I=kg/m2),并对ABO血型的分布及食管/贲门癌患者各级BM I的构成比进行统计学分析。结果:①太行山食管癌高发区食管癌和贲门癌患者ABO血型分布特征均为B>O>A>AB,且不同性别之间无差异(P>0.05);②该地区食管癌和贲门癌患者中正常体重者所占比例均为最多,低体重和超重者次之,肥胖者最少。但是女性食管癌患者中I级BM I所占比例低于贲门癌相应BM I所占比例(22%,69/310vs.27%,18/66),II级BM I所占比例高于贲门癌相应BM I所占比例(54%,169/310vs.49%,32/66)。结论:B型血者患食管/贲门癌的风险较大,AB型血者患食管/贲门癌的风险较低。体重过低的女性患食管癌的风险较其患贲门癌的风险大,而体重在正常范围的女性患贲门癌的风险较大。

高海拔地区进展期胃癌切除修复交叉互补基因1mRNA及蛋白表达与化疗疗效的相关性研究

目的研究高海拔地区进展期胃癌切除修复交叉互补基因1(ERCC1)mRNA和蛋白表达,及其与化疗疗效的相关性。方法逆转录-聚合酶链反应(RT-PCR)检测60例进展期胃癌患者ERCC1mRNA的表达,免疫组织化学法检测ERCC1蛋白的表达并予以FOLFOX4方案化疗,分析ERCC1mRNA及蛋白表达与化疗客观反应率(ORR)和无进展生存期(PFS)的相关性。结果进展期胃癌ERCC1mRNA的表达与化疗疗效(ORR)、PFS呈负相关(P=0.038和0.032);ERCC1蛋白表达与FOLFOX4化疗疗效(ORR)无关(P=0.089),与PFS呈负相关(P=0.039)。结论高海拔地区,进展期胃癌ERCC1mRNA与化疗疗效呈负相关,ERCC1蛋白表达与化疗疗效无关;ERCC1mRNA及蛋白表达与PFS呈负相关。

辉县市人民医院17年(1987～2003)食管和贲门癌3660例住院病例分析

目的 :动态观察辉县市人民医院食管和贲门癌收治病人的临床特征 ,加深对该地区食管和贲门癌发病特征和规律的了解。方法 :严格记录辉县市人民医院 17年间 (87～ 0 3年 )食管和贲门癌患者门诊和住院治疗 (手术 )的记录 ,逐年分析其住院治疗患者的人数 ,年龄和性别分布特征和规律。结果 :所有被调查的上消化道肿瘤患者均来自辉县地区。 17年间共收治 40 70例上消化道肿瘤患者 ,其中食管癌患者 2 668例(66% ) ,贲门癌 965例 (2 4% ) ,胃癌 410例 (10 % ) ,男性食管、贲门和胃癌患者明显多于女性 (66% ,76% ,64 %vs .3 4% ,2 4% ,3 6% ) ,贲门癌患者男女比例最高 (3 .3∶1) ,3 0～ 3 9岁年龄组食管癌患者占 3 % ,贲门癌 1%。结论 :食管和贲门癌仍然是该地区最常见的恶性肿瘤 ,男性明显高于女性 ,并有较明显的年轻化趋势。

2011-2013年寿光市胃癌流行趋势调查

目的：研究2011-2013年寿光市胃癌发病状况,分析胃癌恶性程度的相关因素。方法：选择山东省慢性病检测信息系统及本院内镜室工作站病理确诊的胃癌患者共407例作为研究对象。按照地下水盐碱度将本市分为南部地区（非盐碱地）和北部地区（盐碱地）;按照病理类型将胃癌分为高恶性程度和低恶性程度。分析判断性别、年龄、盐碱地环境与胃癌恶性程度的相关性。结果：（1）407名患者中,以男性居多,占75.4%（307例）,女性24.6%（100例）,平均年龄64.75岁（21~90岁）,男女之比3.07∶1,年发病率约为13.3/10万;（2）男性高恶性程度比例低于女性,60岁以上患者高恶性程度比例低于60岁以下患者,北部地区高恶性程度比例明显高于南部地区,比较差异均有统计学意义（P〈0.05）。结论：（1）本市胃癌发病率男性高于女性;（2）女性、中青年人、北部盐碱地区患者更容易患恶性程度高的胃癌。

农村社区症状性筛选胃癌的临床研究

目的探讨农村地区症状性筛选胃癌,尤其是早期胃癌的重要性和可能性。方法2001年1月至2006年6月间在上海市南汇区航头社区卫生服务中心,对主诉为上腹隐痛饱胀不适的2 717例开展胃镜筛查胃癌研究。结果胃镜活检病理证实食管癌6例(0.22%),胃癌73例(2.69%);手术病理证实进展期胃癌66例(占检出胃癌的90.42%),其中7例未发现转移,59例发现转移;早期胃癌7例(占检出胃癌的9.58%)。结论加强胃癌知识宣传,加强专业人员的技术培训,提高内镜下对早期胃癌的识别能力,农村基层医疗单位亦能检出一定数量的早期胃癌。

胃癌高发区庄河县三种腌制食品的致突变性研究

应用Ａｍｅｓ试验对胃癌高发区庄河县三种腌制食品咸鱼干、咸猪肉及酸菜中可能存在的致突变物或致癌物进行了筛选。结果发现Ｎ－亚硝基化合物、苯并（ａ）芘、霉菌毒素、杂环胺类及一些其它致突变物在三种腌制食品中存在的可能性不大。但三种腌制食品亚硝化后均有较强的直接诱变性，提示该地区胃癌高发可能与食品中存在的致突变物前体有关系。

HIF-1?在高原地区胃癌及胃黏膜癌前病变组织中的表达及临床意义

目的探讨缺氧诱导因子-1a(hypoxia inducible factor-1a,HIF-1a)在高原地区胃癌及癌前病变患者中的表达与胃黏膜恶变过程中的临床联系及预后评价.方法利用RT-PCR检测7株胃癌细胞系及其27对胃癌和配癌旁正常组织中HIF-1a的表达;进一步利用组织微阵列和免疫组织化学染色检测37例萎缩性胃炎,34例胃黏膜肠化组织,146例胃癌和57例癌旁正常组织中HIF-1a的表达情况.结果RT-PCR检测显示,HIF-1a在7株胃癌细胞系存在差异表达.同时在胃癌组织的表达水平66.6%(18/27)高于癌旁正常组织14.8%(4/27)(P<0.001).免疫组织化学显示,HIF-1a在癌旁正常组织中表达阳性率为26.3%(15/57);萎缩性胃炎组织为64.8%(24/37);肠化生组织为61.7%(21/34);胃癌组织为56.8%(83/146).并且HIF-1a的表达与年龄相关(P<0.05),而与性别、胃癌的分化程度、胃癌患者临床分期等无关.Kaplan-Meier法和COX多因素回归分析提示HIF-1a高表达是术后胃癌患者独立的危险因素(P<0.001),RR=3.229(95%CI:2.024-5.151).结论HIF-1a表达在胃黏膜恶变过程中表达增加,并且与高原地区胃癌患者不良预后的密切相关.

徐州农村地区胃癌高危人群干预效果分析

目的:评价农村胃癌高危人群综合干预措施的效果。方法:从徐州农村地区选择胃癌高危人群257人进行干预。干预措施包括药物干预和行为干预。干预6个月之后,利用调查问卷收集资料,评价胃癌防治知识及胃癌预测因素的变化。干预1 a后,89人复查幽门螺杆菌感染,111人复查胃镜,依据复查结果评价幽门螺杆菌感染和胃部疾病改善情况。结果:干预后,三餐规律性、腌制食物食用频率、辛辣食物食用习惯、每月食盐量、饮酒习惯等因素较干预前有改善(P<0.05);幽门螺杆菌感染率由干预前的58.4%下降到干预后的40.4%(P=0.002),好转20人(22.4%),无效65人(73.0%),加重4人(4.5%)。胃镜检查结果好转34人(30.6%),无效77人(69.4%)。结论:对农村胃癌高危人群实施行为干预和药物干预,可以提高人群的胃癌防治知识水平,有效控制胃癌前疾病的发生发展。