2012-2018年山东临朐胃癌高发区胃癌早诊率及胃黏膜病变进展规律分析  

Early diagnosis of gastric cancer and progression of gastric lesions 2012-2018 in Linqu,Shandong Province of China

作　　者：吴秀贞[1] 覃向向 李毅[1] 张兰福 张卫东[1] 李文庆[2] 游伟程[2] 王家林 王乐华[1] 张立辉 潘凯枫[2] 刘卫东 WU Xiu-zhen;QIN Xiang-xiang;LI Yi;ZHANG Lan-fu;ZHANG Wei-dong;LI Wen-qing;YOU Wei-cheng;WANG Jia-lin;WANG Le-hua;ZHANG Li-hui;PAN Kai-feng;LIU Wei-dong(Department of Pathology,Linqu County People’s Hospital,Linqu 262600,P.R.China;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Department of Cancer Epidemiology,Peking University Cancer Hospital&Institute,Beijing 100142,P.R.China;Department of Epidemiology,Institute for Gastric Cancer Prevention,Linqu 262600,P.R.China;Department of Education and Prevention,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,P.R.China;Department of Disease Control,Linqu Country Public Health Bureau,Linqu 262600,P.R.China)

机构地区：[1]临朐县人民医院病理科,山东临朐262600 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所流行病学研究室,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [3]临朐县胃癌防治研究所流行病学室,山东临朐262600 [4]山东省肿瘤防治研究院(山东省肿瘤医院)教育预防部,山东第一医科大学(山东省医学科学院),山东济南250117 [5]临朐县卫生局疾控科,山东临朐262600

出　　处：《中华肿瘤防治杂志》2019年第22期1686-1691,1709,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家重点研发计划(2016YFC1302800;2016YFC0901400

摘　　要：目的胃癌是我国常见的恶性肿瘤之一,实施胃癌早诊早治项目被认为是提高胃癌早诊率、识别胃癌前病变的有效方式。本研究基于2012-2018年山东省临朐县早诊早治项目,分析胃癌早诊情况及随访人群胃黏膜病变进展规律,以期为胃癌高发区开展上消化道癌早诊早治项目提供参考。方法采用临朐县上消化道癌早诊早治项目筛查资料,将高级别上皮内瘤变及以上定义为胃癌,描述胃癌检出率和早诊率;首次筛检胃黏膜病变定义为基线胃黏膜病变,分析基线至末次随访胃黏膜病变进展至胃癌的人群分布特征,并通过Kaplan-Meier曲线描绘其进展规律。结果2012-2018年共筛检临朐胃癌高发区18 201人,胃癌检出率1.48%(95%CI为1.31~1.66),早诊率84.01%。筛检胃癌早诊率有逐年升高趋势。胃镜随访人群随访过程中胃癌检出率(2.40%,95%CI为1.88~3.06)和早诊率(100.00%)高于首次筛检时的胃癌检出率(1.32%,95%CI为1.15~1.51)和早诊率(79.13%),χ^2=15.65,P<0.001。临朐县胃癌好发部位依次为胃窦、胃角及胃体。对胃黏膜病变进展规律进行研究发现,男性进展至胃癌的风险是女性的4.70倍,χ^2=12.84,P<0.001。不同基线胃黏膜病变进展至胃癌的风险差异有统计学意义,χ^2=19.27,P=0.002。Kaplan-Meier曲线显示,低级别上皮内瘤变进展至胃癌的速度和累积风险要高于其他胃黏膜病变。结论临朐县开展的上消化道癌早诊早治项目显著提高了胃癌的早诊率。本研究揭示了高发区胃癌筛查效果、好发部位及胃黏膜病变进展规律,为高发区内镜筛查和人群随访提供了重要证据。OBJECTIVE Gastric cancer(GC)is one of the most common malignancies in China.The program of early detection and treatment of upper gastrointestinal(UGI)cancer is an effective way to improve the early diagnosis rate and detect precancerous lesions.This study aimed to describe the findings from endoscopic screening program of Linqu in Shandong province from 2012 to 2018.METHODS High-grade intraepithelial neoplasia(HGIN)and above were defined as GC.Detection rate and early diagnosis rate of GC and the sites of gastric lesions were summarized.Subsequently,we described the distribution characteristics of followed and unfollowed participants.Then epidemiological characteristics of followed participants who progressed to GC were analyzed and the progression pattern was outlined by Kaplan-Meier.RESULTS Totally 18 201 participants were screened from 2012 to 2018,the detection rate and early diagnosis rate of GC were 1.48%(95%CI:1.31-1.66)and 84.01%,respectively.Early diagnosis rate showed an uptrend by year(χ^2=2.18,P=0.141).The detection rate(2.40%,95%CI:1.88-3.06)and early diagnosis rate(100.00%)of follow-up participants during follow-up screening were higher than the first screening(χ^2=15.65,P<0.001).GC were mainly located in antrum,angulus and corpus.Men were 4.70-fold more likely to progress to GC than women(χ^2=12.84,P<0.001).Baseline gastric lesions were significantly associated with the risk of progression to GC(χ^2=19.27,P=0.002).Those with low-grade intraepithelial neoplasia had particularly higher risk of progression than other lesions.CONCLUSIONS Implementing screening program is beneficial to increase the detection rate of GC.Our study could provide important evidence for endoscopic screening and follow-up in high-risk area of GC.

关 键 词：胃癌 胃黏膜病变 内镜筛检 进展规律 

分 类 号：R73-31[医药卫生—肿瘤] R735.2[医药卫生—临床医学]