健康人群恶性肿瘤的检出分布对肿瘤筛检策略的警示  

Warning of Malignant Tumor Prevalence Detected by Physical Examination in Healthy Populations to Cancer ScreeningStrategies

作　　者：吴艳芬 冯美静[1] WU Yanfen;FENG Meijing(Health Control Department,Aerospace Center Hospital,Beijing 100039,China)

机构地区：[1]航天中心医院健康管理部,北京市100039

出　　处：《中国全科医学》2020年第21期2658-2663,共6页Chinese General Practice

摘　　要：背景我国恶性肿瘤的发病率总体呈现上升趋势,早发现、早治疗是改善恶性肿瘤患者预后甚至是根治恶性肿瘤的先决条件。然而,如何在肿瘤筛检项目中找到可靠、低成本的肿瘤筛检方法值得临床探究。目的了解恶性肿瘤在健康体检人群中的检出分布及其检出方法,以利于今后更好地进行肿瘤筛查工作。方法回顾性分析2016年1月—2018年12月在航天中心医院健康管理部健康体检者共185938例(已排除既往有恶性肿瘤者)的体检结果(男性105204例,女性80734例),根据年龄分为≤29岁、30~44岁、45~59岁、60~74岁、≥75岁五个年龄组,筛选出各检查方法提示恶性肿瘤高风险者,追踪随访其进一步检查诊断结果,统计其中确诊恶性肿瘤病例数。结果确诊为恶性肿瘤患者153例,检出前5位的恶性肿瘤依次为肺癌(0.21‰)、甲状腺癌(0.12‰)、乳腺癌(0.11‰)、肝癌(0.09‰)、宫颈癌(0.06‰)。60~74岁年龄组恶性肿瘤检出率最高(2.30‰),其他组肿瘤检出率依次由高到低为≥75岁年龄组(1.75‰),45~59岁年龄组(1.46‰),30~44岁年龄组(0.38‰),≤29岁年龄组(0.15‰)。男性肺癌和肝癌检出率(分别为0.28‰、0.13‰)高于女性(分别为0.12‰、0.02‰)(χ^2=4.318,χ^2=5.032,P均<0.05)。女性乳腺癌、甲状腺癌检出率(分别为0.26‰、0.22‰)高于男性(分别为0、0.05‰)(χ^2=27.368,χ^2=9.989,P均<0.01)。检出方法主要为胸部CT或数字X线摄影技术(DR)、超声、肿瘤标志物、宫颈液基薄层细胞学检查(TCT)。肺癌主要由胸部CT/DR检出,超声是盆腹腔及腺体肿瘤筛检的主要手段,肿瘤标志物是肝癌、胰腺癌、胃癌、结直肠癌、前列腺癌的灵敏度及特异度高的检出方法。结论在健康体检人群中进行恶性肿瘤筛查意义重大,恶性肿瘤高发年龄段为60~74岁,主要检出方法为胸部CT或DR、超声、肿瘤标志物、TCT,对高发病率的恶性肿瘤进行早筛尤为重要。体�Background The incidence of malignant tumors is on the rise in China.Early detection andtreatment are very important to improve the prognosis and even cure malignant tumors.However, how to find a reliable andlow-cost tumor screening method in the tumor screening project is worthy of clinical exploration.Objective To investigatethe prevalence and screening methods of malignant tumors in physical examination in healthy populations,providing areference for bettering tumor screening.Methods Participants were 185 938 physical examinees(105 204 men and80 734 women without a history of having malignant tumors,stratified into 5 age groups of ≤ 29,30-44,45-59,60-74,and ≥ 75) from Health Control Department,Aerospace Center Hospital,from January 2016 to December 2018.Byretrospectively analyzing their physical examination results,those who had positive results indicating high risk of malignanttumors were screened,and were followed up to explore the subsequent diagnosis,and among them those who were confirmed witha malignant tumor were counted.Results In our study,153 cases were diagnosed with malignant tumors,and the top five in turnwere lung cancer(0.21 ‰),thyroid cancer(0.12 ‰),breast cancer(0.11 ‰),liver cancer(0.09 ‰),and cervicalcancer(0.06‰).The detection rate of malignant tumor was the highest in the 60-74 age group(2.30‰),followed by ≥ 75age group(1.75 ‰),45-59 age group(1.46 ‰),30-44 age group(0.38 ‰) and ≤ 29 age group(0.15 ‰).Comparedwith women,men showed higher lung cancer〔0.28‰ vs 0.12‰〕and liver cancer detection rate〔0.13‰ vs 0.02‰〕(χ^2=4.318,5.032,P<0.05).Women had higher detection rates of breast cancer〔0.26‰ vs 0〕and thyroid cancer〔0.22‰ vs 0.05‰〕thanmen (χ^2=27.368,9.989,P<0.01).The main detection methods used were chest CT or DR,ultrasound,tumor markers andliquid-based cytology test ThinPrep.Lung cancer was mainly detected by lung CT/DR.Ultrasound was the main means of screeningpelvic and peritoneal and glandular tumors.Measuring tumor makers was

关 键 词：肿瘤 肿瘤筛查 健康调查 筛查策略 

分 类 号：R739.9[医药卫生—肿瘤]