海宁市结直肠癌早诊早治筛查项目绩效评估

目的对海宁市结直肠癌早诊早治筛查项目的绩效进行评估,为政府和卫生行政部门制定结直肠癌防控措施与决策提供科学依据。方法对海宁市40~74岁目标人群进行结直肠癌早诊早治筛查,筛查方法包括危险因素量化评估问卷和粪便隐血试验(FOBT),将病史阳性或FOBT阳性者确定为高危人群,然后进一步进行结肠镜检查,对初筛顺应率、初筛阳性率、结肠镜检出率、早诊率、治疗率、筛查经费和筛查成本等工作绩效指标进行分析,并计算早期病例成本系数(EDCI)综合评价指标。结果 2007-2012年,286 470人完成结直肠癌初筛,初筛顺应率为88.96%;危险因素量化评估问卷结果阳性者16 807例,阳性率为5.87%,FOBT阳性25928例,阳性率为11.04%;经初筛确定高危人群为40 103例,占筛查人数的14.00%,需进一步作结肠镜精筛。完成肠镜检查者为29 069例,顺应率为72.90%;检出进展期以上病变1570例,检出率为5.40%,其中早期病例1 526例,早诊率为97.20%,对筛检出的病例及时实施干预措施,治疗率为99.68%。2008-2013年,筛查组随访观察478 929人年,后续结直肠癌发病率为10.65/10万,未筛查组观察266 715人年,发病率为24.75/10万,差异有统计学意义(χ2=21.699,P0.01)。2007-2009年最早开展结直肠筛查的3个乡镇筛查后5年比前5年结直肠癌死亡率下降了39.53%。各级财政历年共下达项目经费为1 234.30万元,早期病例平均每例筛查费用为8 088.47元,早期病例成本系数(EDCI)为0.12。结论海宁市结直肠癌早诊早治筛查项目成效显著,筛查成本符合当地经济发展水平,具有良好的社会效益。     

济南市历下区居民肺癌低剂量螺旋CT自愿筛查结果和成本分析

目的了解山东省济南市历下区居民肺癌低剂量螺旋CT(LDCT)自愿筛查结果及其成本,为政府部门制定相关政策措施和肺癌防治策略提供科学依据。方法收集2015年9月—2017年3月自愿到济南市第八人民医院进行肺癌LDCT筛查的5 937名历下区居民的筛查结果,并以检出率、早诊率、筛查成本、成本效果比(CER)、早期发现成本系数(EDCI)等指标评价该肺癌筛查项目成效。结果山东省济南市历下区5 937名自愿进行肺癌LDCT筛查的居民中,发现阳性结节者89例和疑似肺癌患者34例,最终经病理确诊检出肺癌患者20例(早期肺癌患者12例,晚期肺癌患者8例),肺癌检出率为336.9/10万,早诊率为60%;本次肺癌筛查总费用为1 827 233元,平均每人筛查费用为307.77元,CER为91 361.65元,EDCI为2.24。结论 LDCT可在肺癌筛查中发现较多早期病例,本次自愿筛查项目成本效果较好,但在筛查前初筛高危人群更具收益。     

低剂量螺旋CT和痰液基薄层细胞学联合筛查社区肺癌高危人群的研究

目的 评价低剂量螺旋CT（low-dose computed tomography, LDCT）和痰液基薄层细胞学检测（thinprep cytologic test, TCT）对社区肺癌高危人群的联合筛查效果。方法 对2013年8月~2014年9月在社区招募符合本研究高危人群定义的3 708名东莞本地居民进行肺癌筛查。肺癌高危人群定义为符合下列任何一项的40岁以上者:20包年以上的吸烟史,肺癌家族史,肺部既往病史,职业接触史或被动吸烟史。发现至少一个直径≥4 mm 非钙化结节为LDCT筛查的阳性结果;细胞学重度不典型增生或镜检可见癌细胞为TCT检查的阳性结果。结果 LDCT肺部结节的检出率为12.59%（467/3 708）。经病理证实,LDCT筛查阳性人群中共确诊肺癌56例,检出率为1.51%（56/3 708）。TCT的阳性检出率为1.91%（71/3 708）。TCT阳性人群中共确诊肺癌36例,肺癌检出率为0.97%（36/3 708）。本次联合筛查共确诊肺癌58例,非小细胞肺癌41例,其中0～Ⅰ 期22例,早期诊断率为53.66%（22/41）。结论 LDCT和TCT联合筛查肺癌高危人群有助于提高肺癌的早期诊断率和检出率,降低筛查的假阳性比例。     

9省市将开展城市癌症早诊早治工作

11月1日,卫生部发布《城市癌症早诊早治项目管理办法(试行)》,将在北京、河北等9个省(市),率先开展肺癌、乳腺癌、大肠癌、上消化道癌和肝癌高危人群的评估、筛查和早诊早治,对每个癌种开展卫生经济学评估,每个省(市)都将完成5万人的高危人群评估工作,并对1万高危人群进行癌症筛查,共计9万人。     

辽宁省肺癌高发农村地区1 381名肺癌高危人群筛查结果分析

目的 分析肺癌高危筛查人群特征及高危因素,为完善肺癌筛查方案提供依据。 方法 根据《癌症早诊早治肺癌筛查及早诊早治技术方案2015年试行版》,在辽宁省肺癌高发地区(丹东东港市和朝阳北票市)利用问卷对肺癌高危人群进行筛查,分析高危人群的分布情况及高危因素对肺癌的影响。 结果 52 600人纳入筛查覆盖范围,从中筛选出符合高危标准的1 381人。 在高危人群中,吸烟暴露率最高为95.51%,室内污染暴露率80.38%,职业史、既往疾病史和家族史暴露率分别为1.81%、19.19%和26.00%,多个危险因素暴露率为95.94%,其中吸烟与室内污染同时暴露率为76.76%。通过低剂量螺旋CT检查,检出肺癌患者15例,检出率为1.09%,15名肺癌检出者均暴露于吸烟或室内空气污染。 结论 吸烟和室内污染在高危人群中分布最广,包含了99.13%的高危人群和100%肺癌阳性人群,提示可以简化筛查条目,即仅通过吸烟和室内污染情况筛查人群,减少筛查时间,并可避免因隐私、记忆等问题不愿意暴露或者描述不清自己或者亲属的状况发生。     

低剂量CT联合肿瘤标志物对肺癌高危人群的筛查效果

目的探讨低剂量CT联合肿瘤标志物对肺癌高危人群的筛查效果。方法选取2018年6月至2019年9月在本院体检的肺癌高危人群694例;随机分为观察组316例,对照组378例。观察组采用低剂量螺旋CT检查,对照组采用胸部X线检查;记录肺癌筛查阳性率。全自动电化学发光免疫分析仪测定癌胚抗原、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、神经元特异性烯醇化酶(NSE)、细胞角质蛋白(CYFRA21-1)水平。根据低剂量CT联合肿瘤标志物筛查情况及病理检查结果将观察组患者分为:初筛阴性亚组,初筛阳性但排除肺癌亚组,肺癌亚组。结果观察组肺癌高危人群中初筛阳性率为13.29%(42/316)、肺癌确诊率为1.90%(6/316),明显高于对照组的初筛阳性率2.38%(9/378)、确诊率0.53%(2/378),差异均有统计学意义(均P<0.01)。血清癌胚抗原、NSE、CYFRA21-1水平在3亚组间比较差异均有统计学意义(均P<0.01);其中肺癌组患者血清癌胚抗原、NSE、CYFRA21-1水平明显高于初筛阴性组、初筛阳性但排除肺癌组。多因素Logistic回归分析显示,年龄、吸烟指数、肺癌家族史、职业有害因素接触史是肺癌高危人群中低剂量螺旋CT初筛阳性的独立影响因素(均P<0.05)。结论低剂量CT联合癌胚抗原、NSE、CYFRA21-1能够明显提升肺癌高危人群的筛查确诊率,对合并高危因素的人群应增加筛查频率。     

2014-2018年河南省农村癌症早诊早治项目地区人群食管癌筛查效果分析

目的:分析2014-2018年河南省农村上消化道癌早诊早治项目食管癌筛查结果。方法:根据农村上消化道癌早诊早治项目要求,在河南省农村食管癌高发地区的16个县/县级市,从2014年7月至2019年6月,以乡/村为单位进行整群抽样,纳入符合标准的40~69岁人群作为初筛人群,采用内镜碘染色及指示性活检方法开展人群食管癌筛查。对筛查确认的轻度、中度异型增生对象进行随访。计算筛查人群食管疾病分布,采用卡方检验比较初筛人群和随访人群重度增生及以上者的检出率差异及早诊率差异。结果:116 630名初筛人群年龄为(54.29±7.70)岁,男性占比41.20%(48 108人)。初筛人群中食管正常者、轻中度异型增生者、重度异型增生及以上病变者分别占92.91%(108 363人)、6.03%(7 035人)、1.06%(1 232人);食管癌检出率为1.06%(1 232/116 630),早诊率为85.80%(1 057/1 232)。6 154名随访人群食管正常者、轻中度异型增生者、重度异型增生及以上病变者分别占63.45%(3 905人)、33.13%(1 519人)、3.41%(210人);食管癌检出率为3.41%(210/6 154),早诊率为91.90%(193/210)。与初筛人群相比,随访人群的食管癌的检出风险增加, OR(95% CI)值为3.23(2.78,3.75),其中首次筛查诊断为轻度异型增生者及中度异型增生者检出风险较初筛人群增加, OR(95% CI)值分别为1.85(1.49,2.29)、8.13(6.69,9.88)。 结论:2014-2018年河南省农村上消化道癌早诊早治项目随访人群检出率高于初筛人群。提高随访率,重视需随访人群的筛查可进一步提高筛查效果。     

《城市癌症早诊早治项目管理办法(试行)》

1 项目目标 在全国9个省份的城市人群中开展肺癌、乳腺癌、大肠癌、上消化道癌和肝癌高危人群的评估、筛查和早诊早治,每省份共完成危险因素调查和高危人群评估5万人,对1万高危人群进行癌症筛查,对每个癌种开展卫生经济学评估. 研究和评估城市中五大高发癌症高危人群筛查和早诊早治适宜技术,建立并完善防治工作体系和长效机制,加强能力建设,努力降低城市中癌症发病率、复发率、致残率和死亡率;开展卫生经济学评估,找到适合城市实际情况的、投入产出比高的癌症筛查和早诊早治技术和方案,进一步在全国推广.     

莘庄社区肺癌高危人群低剂量螺旋CT筛查结果分析

目的了解低剂量螺旋CT(LDCT)在社区肺癌高危人群中筛查的效果,为肺癌早期筛查提供方法。方法于2013年8月至2017年7月对莘庄社区1 261名符合肺癌高危人群标准的居民在辖区内同一家二级医院进行LDCT筛查,将筛查结果为阳性的居民转诊至三级专科医院进一步明确诊断。采用SPSS 18.0软件进行t检验和χ2检验。结果 1 261名肺癌高危人群中,检出肺癌22例,检出率为1.74%,其中0～Ⅰ期10例,占肺癌检出病例的45.46%(10/22)。年龄≥55岁居民肺异常及肺相关疾患比例(52.99%)高于年龄55岁居民(26.06%),男性(55.52%)高于女性(44.17%),差异均有统计学意义(P0.01)。有肺部疾病史的居民肺结节阳性率(16.55%)高于无肺部疾病史的居民(14.93%),差异有统计学意义(P0.05)。筛查结节阳性者193例,其中检出肺癌15例,检出率为7.77%,其中部分实性结节者37例,其中检出肺癌6例,检出率最高(16.22%),差异有统计学意义(P0.05)。结论采用LDCT筛查肺癌高危人群能有效发现肺部病变,提高肺癌早期诊断率。     

广州地区肺癌高危人群筛查依从性及筛查结果分析

目的调查广州地区肺癌高危人群筛查依从性现状及影响因素,并分析肺癌筛查结果。方法选取2020年1月至2021年12月广州地区常住居民为研究对象,通过问卷收集其社会人口学资料及肺癌危险因素资料,筛查出肺癌高危人群,肺癌高危者由专业放射科医生进行低剂量螺旋CT(LDCT)扫描并根据诊断标准完成诊断。采用描述性分析方法对高危人群筛查依从性及筛查结果进行分析,并采用单、多因素分析方法对肺癌高危人群筛查依从性影响因素进行分析。结果17980名研究对象中肺癌高危评估率为19.96%(3589/17980),LDCT筛查依从率为34.99%(1256/3589)。3589例肺癌高危人员的肺癌确诊率为2.17%(78/3589),其中男性占61.54%(48/78),女性占38.46%(30/78),40~50岁占17.95%(14/78)、51~60岁占33.33%(26/78)、61~74岁占48.72%(38/78)。Logistic回归分析显示,女性(OR=2.130)、年龄越大(OR=1.408)、BMI≥24.0 kg/m2(OR=2.349、2.375)、中专及以上受教育程度(OR=2.008、3.251)、饮酒(OR=1.498)、吸烟(OR=2.239)、被动吸烟(OR=2.428)、有肺癌家族史(OR=2.081)、有慢性呼吸系统疾病史(OR=2.006)及不经常体育锻炼(OR=2.130)的肺癌高危者具有更高的筛查依从性。结论广州地区肺癌高危人群筛查依从性普遍较低,年龄、受教育程度、家族病史等均与筛查依从性有关,肺癌高危筛查有助于早期诊断肺癌及相关疾病,改善国民生活质量。     

北京市肺癌发病率、死亡率和生存率分析

根据北京市肿瘤登记报告所积累的资料,对1977~1986年的肺癌病例进行了核实整理、随防和分析。分析结果表明:近十年来北京市肺癌居各种恶件肿瘤发病率和死亡率的首位,且有逐年上升的趋势。1982~1984年北京市城区居民中男性肺癌年龄调整发病率为33.0/10万,占男性全部癌瘤发病总数的20.3%,女性肺癌调整发病率为21.1/10万,占女性全部癌瘤的16.1%。肺癌调整发病率性比值(男:女)为1.56。以北京市肺癌与部分国家和地区的肺癌比较,结果表明北京市肺癌流行特征是性比值低,女性肺癌相对突出。天津、上海和北京女性肺癌水平接近,同属于高发之列。     

Screening for lung cancer: A systematic review and meta-analysis

ObjectivesTo examine evidence on benefits and harms of screening average to high-risk adults for lung cancer using chest radiology (CXR), sputum cytology (SC) and low-dose computed tomography (LDCT).MethodsThis systematic review was conducted to provide up to date evidence for Canadian Task Force on Preventive Health Care (CTFPHC) lung cancer screening guidelines. Four databases were searched to March 31, 2015 along with utilizing a previous Cochrane review search. Randomized trials reporting benefits were included; any design was included for harms. Meta-analyses were performed if possible. PROSPERO #CRD42014009984.ResultsThirty-four studies were included. For lung cancer mortality there was no benefit of CXR screening, with or without SC. Pooled results from three small trials comparing LDCT to usual care found no significant benefits for lung cancer mortality. One large high quality trial showed statistically significant reductions of 20% in lung cancer mortality over a follow-up of 6.5 years, for LDCT compared with CXR. LDCT screening was associated with: overdiagnosis of 10.99–25.83%; 11.18 deaths and 52.03 patients with major complications per 1000 undergoing invasive follow-up procedures; median estimate for false positives of 25.53% for baseline/once-only screening and 23.28% for multiple rounds; and 9.74 and 5.28 individuals per 1000 screened, with benign conditions underwent minor and major invasive follow-up procedures.ConclusionThe evidence does not support CXR screening with or without sputum cytology for lung cancer. High quality evidence showed that in selected high-risk individuals, LDCT screening significantly reduced lung cancer mortality and all-cause mortality. However, for its implementation at a population level, the current evidence warrants the development of standardized practices for screening with LDCT and follow-up invasive testing to maximize accuracy and reduce potential associated harms.     

Cancer-Specific Mortality,All-Cause Mortality,and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

PURPOSEBenefit of lung cancer screening using low-dose computed tomography (LDCT) in reducing lung cancer–specific and all-cause mortality is unclear. We undertook a meta-analysis to assess its associations with outcomes.METHODSWe searched the literature and previous systematic reviews to identify randomized controlled trials comparing LDCT screening with usual care or chest radiography. We performed meta-analysis using a random effects model. The primary outcomes were lung cancer–specific mortality, all-cause mortality, and the cumulative incidence ratio of lung cancer between screened and unscreened groups as a measure of overdiagnosis.RESULTSMeta-analysis was based on 8 trials with 90,475 patients that had a low risk of bias. There was a significant reduction in lung cancer–specific mortality with LDCT screening (relative risk = 0.81; 95% CI, 0.74-0.89); the estimated absolute risk reduction was 0.4% (number needed to screen = 250). The reduction in all-cause mortality was not statistically significant (relative risk = 0.96; 95% CI, 0.92-1.01), but the absolute reduction was consistent with that for lung cancer–specific mortality (0.34%; number needed to screen = 294). In the studies with the longest duration of follow-up, the incidence of lung cancer was 25% higher in the screened group, corresponding to a 20% rate of overdiagnosis.CONCLUSIONSThis meta-analysis showing a significant reduction in lung cancer–specific mortality, albeit with a tradeoff of likely overdiagnosis, supports recommendations to screen individuals at elevated risk for lung cancer with LDCT.Key words: lung cancer, cancer screening, mass screening, low-dose computed tomography, overdiagnosis, public health, preventive medicine, health services     

基于竞争风险模型的离退休人员白内障发病的影响因素分析

目的 应用竞争风险模型,探究离退休人员白内障发病的影响因素,为离退休人员的白内障预防和早期干预提供科学依据。方法 将历年参与杭州市萧山区55岁及以上离退休人员体检项目的人员作为研究对象,纳入前瞻性队列研究,收集研究对象所有可能的影响因素,拟合竞争风险模型,分析研究对象白内障发病的影响因素。结果 纳入队列的研究对象共计2 181人,经过8年的随访失访188人,发生白内障（终点事件）923人,发病率为42.3%,在发生白内障之前死亡或失明（竞争事件）294人,累积观察到12 575人年,竞争风险模型分析显示,在有竞争事件的影响下,女性（HR=1.371, 95%CI:1.202～1.565）、年龄≥70岁（HR=1.027, 95%CI:1.020～1.034）、教育程度为中学（HR=1.940, 95%CI:1.673～2.250）或大专及以上（HR=1.301, 95%CI:1.104～1.533）、高血压（HR=1.384, 95%CI:1.216～1.575）、糖尿病（HR=1.303, 95%CI:1.144～1.484）、高血脂（HR=1.209, 95%CI:1.063～1....     

Should we screen for occupational lung cancer with low-dose computed tomography?

OBJECTIVE: The objective of this study was to assess the potential value of screening for occupational lung cancer through the use of low-dose computed tomography (LDCT). METHODS: A literature review of Medline was conducted to assess: 1) screening studies of occupational lung cancer that used LDCT; 2) screening studies of nonoccupational lung cancer that used LDCT; and 3) position papers of medical professional societies and nongovernmental health organizations that have addressed the value of screening for lung cancer with LDCT. RESULTS: No screening studies of occupational lung cancer with LDCT were uncovered; however, numerous observational and population-based studies have addressed the value of screening for lung cancer among cigarette smokers. Results of these studies are difficult to interpret in light of numerous biases associated with these types of studies. No randomized, controlled studies on screening for lung cancer have been published at this time. No professional, governmental, or nonprofit health organization recommends screening asymptomatic people at risk of lung cancer with LDCT at this time. CONCLUSION: In the absence of randomized, controlled studies that can address biases commonly encountered in observational and population-based studies, it is unclear whether LDCT reduces mortality from lung cancer. The National Cancer Institute is sponsoring a randomized, controlled study of over 50,000 current and former smokers with the results expected in 2009.     

Lung cancer screening: a review of available data and current guidelines

Lung cancer is the leading cause of cancer mortality worldwide. A lack of clinical symptoms in early-stage disease frequently leads to diagnosis at a late stage, and a 15% 5-year survival rate in all patients so diagnosed. This has led to significant interest in effective screening methods to detect early-stage cancers, particularly for high-risk groups, such as current or former smokers. Early clinical trials focused on chest radiograph with or without sputum cytology and failed to show an improvement in mortality with screening. A meta-analysis also failed to show a difference in all-cause mortality. Subsequent protocols compared low-dose computed tomography (LDCT) scan with chest radiograph and documented increased detection of early-stage disease; however, they were not designed to prove a reduction in mortality. The most recent trials have focused on LDCT scans, including the National Lung Screening Trial. Data released from the National Lung Screening Trial demonstrated a statistically significant reduction in lung cancer deaths in patients screened with LDCT scans. When data from the study, including cost-effectiveness, are completely analyzed, they may lead to revision of current lung cancer screening recommendations to include LDCT scans in specific populations at high risk of developing lung cancer.     

Cost-Effectiveness of Baseline Low-Dose Computed Tomography Screening for Lung Cancer: The Israeli Experience

ObjectiveReduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel.MethodsA decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases—lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated.ResultsBase-case incremental cost per QALY gained was $1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than $10,000 with probability 0.937 and is lower than $20,000 with probability 0.978.ConclusionsOur analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.     

代谢综合征与女性乳腺癌发病风险的前瞻性队列研究

目的研究代谢综合征(MS)与女性乳腺癌发病风险关联。方法基于“开滦女性动态队列”,于2006年5月至2015年12月,纳入25618名开滦集团在职及离退休女性职工为研究对象,并进行随访。采用问卷调查、身体测量和实验室检测的方法收集基线社会人口学特征、身高、体重、血糖、血脂、血压及肿瘤发病结局信息。采用Cox比例风险回归模型分析MS及其组分(体重指数、血压、血糖、血脂)与女性乳腺癌发病风险的关系。结果25618名研究对象年龄为(47.65±12.02)岁,中位随访时间为8.78年;乳腺癌新发病例为235例,发病密度为113.19/10万人年。调整年龄、教育程度、经济收入、吸烟状态、饮酒状态等因素后,与体重指数正常者相比,超重或肥胖者的乳腺癌发病风险较高,HR(95%CI)值为1.47(1.12~1.93);与无MS异常组分相比,具有2个MS异常组分的女性乳腺癌发病风险增加(HR=1.70,95%CI:1.16~2.50);随着MS异常组分个数的增加,乳腺癌发病风险逐渐增加(P趋势<0.05)。结论超重/肥胖、MS异常组分的个数均可增加女性乳腺癌发病风险。