结肠镜和粪便隐血试验及新型风险评估筛查方案在徐州市人群结直肠癌筛查中应用效果比较  

Comparison of application effects of colonoscopy, fecal immunochemical test and a novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population

作　　者：孔蕴馨 董栋[1] 陈宏达 代敏 卓朗 娄培安[4] 蔡婷 陈思婷 潘建强 高以焕 路航 董宗美 赵鸿鹰 罗小虎[1] 陈国慧[1] Kong Yunxin;Dong Dong;Chen Hongda;Dai Min;Zhuo Lang;Lou Peian;Cai Ting;Chen Siting;Pan Jianqiang;Gao Yihuan;Lu Hang;Dong Zongmei;Zhao Hongying;Luo Xiaohu;Chen Guohui(Cancer Prevention and Control Office,Xuzhou Cancer Hospital,Xuzhou 221000,China;Medical Research Center,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China;School of Public Health,Xuzhou Medical University,Xuzhou 221004,China;Chronic Disease Prevention and Control Department,Xuzhou Center for Disease Control and Prevention,Xuzhou 221000,China;School of Management,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州市肿瘤医院肿瘤防治办公室,徐州221000 [2]中国医学科学院北京协和医院医学科学研究中心,北京100730 [3]徐州医科大学公共卫生学院,徐州221004 [4]徐州市疾病预防控制中心慢病科,徐州221000 [5]徐州医科大学管理学院,徐州221004

出　　处：《中华预防医学杂志》2022年第8期1074-1079,共6页Chinese Journal of Preventive Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-006);国家重大公共卫生服务项目(城市癌症早诊早治项目)。

摘　　要：目的比较结肠镜、免疫法粪便隐血实验(FIT)和新型风险评估筛查方案在徐州市人群结直肠癌(CRC)筛查中的应用效果。方法2018年5月至2019年4月于徐州市鼓楼区、云龙区、泉山区招募4280名50~74岁对象,按1∶2∶2比例随机分配为结肠镜组(863名)、FIT组(1723名)和新型风险评估筛查方案组(1694名)。新型风险评估筛查方案组经过风险评估后高风险者邀请接受结肠镜检查,低风险者邀请接受FIT检查,所有FIT阳性者均邀请进行结肠镜检查。计算并比较各组结肠镜参与率[(完成结肠镜人数/邀请参与结肠镜人数)×100%]、结直肠病变检出率[(确诊人数/完成结肠镜人数)×100%]、结肠镜资源负载(完成结肠镜检查人数/确诊进展期肿瘤人数)和FIT资源负载。结果4280名对象年龄为(61±6)岁,其中男性1816名(42.43%),不同筛查方案组对象的社会人口学特征差异无统计学意义。结肠镜组、FIT组、新型风险评估筛查方案组的结肠镜参与率分别为22.60%(195/863)、57.04%(77/135)、33.94%(149/439),FIT组高于结肠镜组和新型风险评估筛查方案组,新型风险评估筛查方案组高于结肠镜组(均P<0.001);进展期肿瘤检出率分别为6.67%(13/195)、9.09%(7/77)、8.72%(13/149),差异无统计学意义(P>0.05)。结肠镜组、FIT组、新型风险评估筛查方案组结肠镜资源负载(95%CI)分别为15(13~17)、11(9~14)和11(10~13)名,其中新型风险评估筛查方案组中高风险个体结肠镜资源负载为12(9~15)名。FIT组和新型风险评估筛查方案组FIT资源负载(95%CI)分别为207(196~218)和88(83~94)名。结论风险评估模型与FIT的综合应用在结直肠癌筛查中可能有一定效果。Objective To compare the application effect of the colonoscopy,fecal immunochemical test(FIT)and novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population.Methods From May 2018 to April 2019,4280 subjects aged 50-74 were recruited from Gulou district,Yunlong district and Quanshan district of Xuzhou.They were randomly assigned to the colonoscopy group(n=863),FIT group(n=1723)and novel risk-adapted screening approach group(n=1694)according to the ratio of 1∶2∶2.For the novel risk-adapted screening approach group,after the risk assessment,high-risk subjects were invited to undergo colonoscopy and low-risk subjects were invited to undergo FIT examination.All FIT positive subjects were invited to undergo colonoscopy.Colonoscopy participation rate[(the number of colonoscopies completed/the number of colonoscopies invited to participate)×100%],detection rate of colorectal lesions[(the number of diagnosed patients/the number of colonoscopies completed)×100%],colonoscopy resource load(the number of colonoscopies completed/the number of diagnosed advanced tumors)and FIT resource load in each group were calculated and compared.Results The age of all subjects was(61±6)years old,including 1816 males(42.43%).There was no statistically significant difference in the socio-demographic characteristics of the subjects in different screening groups.The colonoscopy participation rate was 22.60%(195/863)in the colonoscopy group,57.04%(77/135)in the FIT group,and 33.94%(149/439)in the novel risk-adapted screening approach group,respectively.The colonoscopy participation rate was higher in the FIT group than in the colonoscopy group and the novel risk-adapted screening approach group(P<0.001).The colonoscopy participation rate of novel risk-adapted screening group was significantly higher than the colonoscopy group(P<0.001).The detection rates of advanced tumors were 6.67%(13/195),9.09%(7/77)and 8.72%(13/149),respectively,and the difference was not statistically significant(P>0.05).The colonoscopy

关 键 词：结直肠肿瘤 多相筛查 方案评价 结果与过程评价(卫生保健) 筛查 

分 类 号：R735.34[医药卫生—肿瘤]