磁县上消化道癌早诊早治筛查队列随访与癌症发病死亡的影响分析  

Cohort study in area with high incidence of upper gastrointestinal cancer in Cixian,China

作　　者：宋国慧 孟凡书 陈超 龚妍玮 高志光 白文龙 靳国梁 陈茹 魏文强 王贵齐 曹玉[4] 张立玮[4] SONG Guo-hui;MENG Fan-shux;CHEN Chao;GONG Yan-wei;GAO Zhi-guangx;BAI Wen-Iong;JIN Guo-Liang;CHEN Ru;WEI Wen-qiang;WANG Gui-qi;CAO Yu;ZHANG Li-wei(De pa rtment of Cancer Epidemiology,Cixian Institute for Cancer Prevention and Control,Cijcian Cancer Hospital,Handan 056500,P.R.China;Cancer Registry Office,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,P.R.China;Office of Cancer Early Diagnosis and Treatment,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,P.R.China)

机构地区：[1]磁县肿瘤防治研究所/磁县肿瘤医院流行病学研究室,河北邯郸056500 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤登记办公室,北京100021 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院内镜室,北京100021 [4]河北医科大学第四医院河北省癌症早诊早治项目办公室,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2020年第18期1455-1463,共9页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家重点研发计划(2016YFC0901400,2016YFC1302800);国家自然科学基金(81974493);中国医学科学院医学与健康科技创新工程(2019-I2M-2-004)。

摘　　要：目的上消化道癌是我国常见恶性肿瘤之一,发病率和死亡率高于世界平均水平。本研究通过高发现场上消化道癌筛查队列研究,评价内镜筛查对磁县上消化道癌的防治效果,探讨筛查对上消化道癌发病、死亡的影响,为肿瘤防治策略制定提供依据。方法本研究选用磁县2005-2013年逐年度完成的内镜筛查人群。筛查人群界定为40~69岁目标人群,全部人群建立研究队列数据库,干预组为71 923人(男34 157人,女37 766人),其中参加内镜检查的筛查组为22 135人,未筛查组为49 788人;对照组为19 384人(男9 376人,女10 008人),所有覆盖人群与对照组人群都通过与肿瘤登记数据库匹配建立数据库,再结合随访观察肿瘤自然发病与死亡情况,肿瘤发病死亡登记应用ICD10统计。分析队列人群中上消化道癌、食管癌、胃癌和全部恶性肿瘤发病和死亡率的相对危险度,进一步比较各组,观察逐年度累积率变化趋势。结果通过11年随访,相对于对照组,内镜筛查组上消化道癌发病率和死亡率显著降低。干预组人群上消化道癌的发病率和死亡率分别与对照组相比较,相对危险度RR分别为0.83(95%CI为0.76~0.90,P<0.001)和0.65(95%CI为0.59~0.73,P<0.001),发病和死亡率均明显低于对照组;干预组中的筛查组与对照组相对危险度比较,其下降更为明显,相对危险度RR分别为0.83(95%CI为0.75~0.93,P<0.001)和0.48(95%CI为0.41~0.56,P<0.001),人群上消化道癌早诊早治筛查后对其发病与死亡率下降效果明显。结论内镜筛查可明显降低高发区上消化道癌死亡风险,有效降低发病风险,且影响效果食管癌优于贲门癌和非贲门胃癌。作为较为成熟的筛查技术,上消化道癌内镜筛查与早诊早治覆盖面的进一步扩大将对降低癌症危害、减轻癌症负担起到积极影响。OBJECTIVE To established a cohort of gastrointestinal cancer screening in a high-incidence area,and evaluate the effect of endoscopic screening on upper gastrointestinal cancer in Cixian.METHODS This study selected the endoscopic screening population completed annually from 2005 to 2013 in Cixian.The screening population was defined as the target population from 40 to 69 years old.All the population established a research cohort database.The population of intervention group was 71 923(34 157 males and 37 766 females),of which 22 135 were in the screening group,49 788 were in the non-screening group and 19 384 were in the Control Group(9 376 males and 10 008 females).All the coverage and control groups were matched to the cancer registry database to create a database,and then combined with follow-up to observe the natural morbidity and mortality of the tumor.ICD10 statistics were used for the registration of tumor morbidity and mortality.The relative risk of morbidity and mortality of upper gastrointestinal cancer,esophageal cancer,gastric cancer,and all malignant tumors in the cohort was analyzed,and the groups were further compared to observe the trend of the cumulative rate year by year.RESULTS After 11 years of follow-up,mortality from upper gastrointestinal cancer in the endoscopic screening group was significantly lower than that in the control group.The incidence and mortality of upper gastrointestinal cancer in the intervention group were significantly lower than those in the control group,RR=0.83(95%CI=0.76-0.90,P<0.001)and RR=0.65(95%CI=0.59-0.73,P<0.001).Compared with the Control Group,the relative risk of the screening group in the intervention group decreased significantly,RR=0.83(95%CI=0.75-0.93,P<0.001)and RR=0.48(95%CI=0.41-0.56,P<0.001).The incidence and mortality of upper gastrointestinal cancer decreased significantly after early diagnosis and screening.CONCLUSIONS Endoscopic screening can significantly reduce the risk of death from upper gastrointestinal cancer in high-risk areas and effectivel

关 键 词：上消化道癌 食管癌 非贲门胃癌 贲门癌 筛查 队列研究 相对危险度 累积率 

分 类 号：R730.1[医药卫生—肿瘤]