基于类阶梯设计的肥城市上消化道癌内镜筛查分析  

Endoscopic screening of upper gastrointestinal cancer based on stepped wedge design in Feicheng City

作　　者：魏文剑 李一帆 刘儒月 马思琦 张楠 王家林 WEI Wenjian;LI Yifan;LIU Ruyue;MA Siqi;ZHANG Nan;WANG Jialin(Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan250117,China;School of Public Health,Weifang Medical University,Weifang261053,China)

机构地区：[1]山东省肿瘤防治研究院山东省肿瘤医院人力资源部山东第一医科大学(山东省医学科学院),山东济南250117 [2]山东省肿瘤防治研究院院长办公室山东第一医科大学(山东省医学科学院),山东潍坊261053 [3]潍坊医学院公共卫生学院,山东济南250117

出　　处：《中华肿瘤防治杂志》2023年第8期450-455,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(71904109);山东省自然科学基金(ZR2020KH029)。

摘　　要：目的通过比较肥城市上消化道癌内镜筛查区病例与未筛查区病例的生存差异,探讨上消化道癌症内镜筛查的效果。方法以2011-2013年进行内镜筛查村庄在筛查当年及筛查年前2年的503例新发病例为研究对象,其中男368例,女135例。借鉴类阶梯式试验原理,对人群进行回顾性队列研究。以进行内镜筛查的村庄在筛查当年的全部新发病病例为筛查组病例;筛查年之前2年登记的40~69岁的新发病例为未筛查组病例。采用寿命表法描述筛查组与未筛查组3和5年生存率及95%CI值;log-rank检验比较筛查组与未筛查组上消化道癌症病例的生存曲线差异;Cox回归分析内镜筛查对上消化道癌症患者生存状况的影响。结果筛查组共纳入病例368例,未筛查组共纳入135例。筛查组和未筛查组的3年生存率分别为75.3%(95%CI:70.5~79.4)和31.85%(95%CI:24.2~39.8);5年生存率分别为38.0%(95%CI:33.1~43.0)和26.7%(95%CI:19.5~34.3)。整体筛查组的生存分布优于未筛查组,χ^(2)=100.000,P<0.001。多因素Cox回归结果显示,参与内镜筛查(HR=0.26,95%CI:0.20~0.35)和女性(HR=0.56,95%CI:0.40~0.79)是上消化道癌症的保护因素。结论开展内镜筛查可以有效的发现早期病例,延长了筛查区上消化道癌症患者的生存时间,对减轻当地上消化道癌症疾病负担有重要意义。Objective To investigate the effect of endoscopic screening for upper gastrointestinal cancer by comparing the survival differences between cases in the upper gastrointestinal cancer screening area and those in the non-screening area in Feicheng City.Methods All 503new cases,368males and 135females,from villages undergoing endoscopic screening in 2011-2013and two years prior to screening were used for the study.A retrospective cohort study of the population was conducted drawing on the principles of stepped wedge trials.All new-onset cases in the year of screening in villages where endoscopic screening was performed were used as the screening group cases;new-onset cases aged 40-69years registered two years prior to the screening year were the unscreened group cases.The life table method was used to describe the 3-and 5-year survival rates and 95%CI between the screened and unscreened groups;log-rank tests were used to compare the differences in survival curves between the screened and unscreened groups of upper gastrointestinal cancer cases;Cox regression was used to analyze the effect of endoscopic screening on the survival status of patients with upper gastrointestinal cancer.Result A total of 368cases were included in the screening group,and 135cases were included in the non-screening group.The 3-year survival rates of the screening group and the non-screening group were 75.30%(95%CI:70.5-79.4)and 31.85%(95%CI:24.2-39.8),respectively.The 5-year survival rates were 38.0%(95%CI:33.1-43.0)and 26.7%(95%CI:19.5-34.3),respectively.The overall survival distribution of the screening group was better than that of the non-screening group(χ2=100,P<0.001).Multivariate Cox regression analysis showed that participating in endoscopic screening(HR=0.26,95%CI:0.20-0.35)and being female(HR=0.56,95%CI:0.40-0.79)were protective factors for upper gastrointestinal cancer.Conclusion Endoscopic screening can effectively detect early cases,prolong the survival time of patients with upper gastrointestinal cancer in the screening area,

关 键 词：上消化道癌症 内镜筛查 类阶梯设计 log-rank检验 COX回归分析 

分 类 号：R730.1[医药卫生—肿瘤] R735[医药卫生—临床医学]