中山市小榄镇肝癌高危人群筛查依从性及筛查效果分析  

Compliance and effectiveness of screening in population with high risk for liver cancer in Xiaolan town,Zhongshan city

作　　者：俞霞[1] 程伟民[1] 吴标华[1] 季明芳[1] Xia Yu;Weimin Cheng;Biaohua Wu;Mingfang Ji(Cancer Research Institute of Zhongshan City,Zhongshan Affiliated Hospital of Sun Yat-sen University,Zhongshan 528400,China)

机构地区：[1]中山大学附属中山医院,中山市肿瘤研究所,广东省中山市528400

出　　处：《中国肿瘤临床》2020年第7期350-353,共4页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81672098)资助。

摘　　要：目的:分析广东省中山市小榄镇肝癌高危人群筛查依从性和队列人群后续肝癌患者发病情况。方法:筛查方案参照《中国癌症筛查及早诊早治技术方案(2011年版)进行》,2012年开始对中山市小榄镇进行肝癌筛查,对ELISA法检测发现的乙肝表面抗原(hepatitis B virus surface antigen,HBsAg)阳性者,采用甲胎蛋白(alpha-fetorprotein,AFP)联合超声检查的方法开展每年两次的诊断性筛查。对肝癌高危人群进行随访,随访截至2017年12月31日。统计学分析肺癌的发病率及人群筛选依从性。结果:初筛队列19386人,检出HBsAg阳性者2882人,阳性率14.9%。剔除初筛时发现的13例肝癌,实际随访高危人群2869人。2014~2017年对肝癌高危人群连续4年进行随访,AFP检测依从性(58.9%)显著高于B超检查(57.2%)依从性(P<0.01)。AFP检测和B超检查上半年依从性分别为62.8%和62.2%,下半年依从性分别为55.0%和52.1%,上半年依从性均显著高于下半年(P<0.01)。整体女性筛查依从性高于男性;35~54岁男性随访依从性最低。筛查队列中HBsAg阳性人群肝癌发病率为363.5/105,显著高于HBsAg阴性人群肝癌发病率20.9/105(P<0.05),而两组人群肝癌早诊率差异无统计学意义(57.9%vs.47.4%,P>0.05)。B超高依从组和HBsAg阳性组中肝癌患者生存率分别高于低依从组和HBsAg阴性组(P<0.05)。结论:筛查队列依从性和高危人群肝癌早诊率低。队列中B超检查依从性高的肝癌生存率相对较好。提高HBsAg阳性人群筛查依从性,是提高肝癌早诊率及生存率的重要途径之一。Objective:To evaluate the compliance of participants to recommended liver cancer screening and to assess the incidence of subsequent liver cancer.Methods:Cancer Research Institute of Zhongshan City launched liver cancer screening in 2012,in agreement with the requirements of the Committee on Early Diagnosis and Treatment of Cancer Foundation in China.Enzyme-linked immunosorbent assay(ELISA)for hepatitis B surface antigen(HBsAg)was the initial screening test performed in the population.We proposed that subjects positive for HBsAg undergo biannual screening using serum alpha-fetoprotein(AFP)tests and ultrasonography.All subjects were followed up till the end of December 2017.The prevalence of liver cancer and patients'compliance were statistically analyzed.Results:1)We identified 2,882 HBsAg-positive participants among the total of 19,386 participants in 2012.The HBsAg positivity rate was 14.9%.13 patients with liver cancer,identified in the preliminary screening,were excluded from the study,and the remaining 2,869 participants were followed-up.During four consecutive years(2014-2017),the compliance to AFP testing(58.9%)was higher than that(57.2%)to ultrasonography(P<0.01).The compliance to AFP and ultrasonography in the first half of the year were 62.8%and 62.2%,respectively,and the compliance in the latter half of the year were 55.0%and 52.1%,respectively.The compliance in the first half of the year was higher than that in the latter half of the year(P<0.01).The compliance to screening was higher in women than in men.The compliance was the lowest in men aged 35-44 years.2)The incidence of liver cancer in HBsAg-positive participants and HBsAg-negative participants were 363.5/105 and 20.9/105,respectively.The former was higher than the latter(P<0.05).The rate of early diagnosis(57.9%vs.47.4%)did not differ significantly between the two groups(P>0.05).3)The liver cancer patients in the high compliance to ultrasonography screening and HBsAg-positive groups had better survival rates than those in the low-compliance an

关 键 词：肝癌 筛查 依从性 发病率 生存率 

分 类 号：R735.7[医药卫生—肿瘤]