乌鲁木齐市2015~2016年度城市居民癌症高风险人群筛查分析

目的 了解乌鲁木齐市2015~2016年度城市癌症早诊早治筛查情况,为下年度开展癌症早诊早治项目工作提供依据.方法 选择乌鲁木齐市的高新区(新市区)、水磨沟区、米东区、经济技术开发区、乌鲁木齐县和达坂城区6个项目区作为筛查现场,选择整群抽样的方法,对40~69岁常住居民,开展肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌5大类癌症的流行病学调查和高风险评估.对检出的高危人群进行免费的临床筛查,探讨新疆城市癌症早诊早治的防治效果.结果 共完成高危人群评估50711人,评估出高危人群52655人次,完成临床检查12420人次,其中肺癌3708人次,乳腺癌2649人次,肝癌2919人次,上消化道癌1920人次,结直肠癌1224人次,总任务完成率为124.2%.乳腺癌参与率最高(37.0%),结直肠癌参与率最低(11.8%).共筛查出阳性病例1010例,确诊癌症24例,癌症检出率为193/10万.癌症患者中早期病例19例(79.1%),23例接受治疗,治疗率为95.8%.结论 有针对性对城市高风险人群进行筛查,能够发现早期肿瘤患者.仍需加强癌症防治宣传力度,优化项目筛查流程,提高参与项目的积极性,提高项目筛查效果.     

2014—2019年山东省青岛市城市居民结直肠癌早诊早治项目筛查结果分析

摘 要：［目的］ 分析总结2014—2019年青岛市城市居民结直肠癌高危人群的风险评估及临床筛查结果。［方法］ 通过问卷初筛确定高危人群,通过结肠镜筛查进行精筛,对青岛市2个辖区的结直肠癌高危人群进行结直肠癌及癌前病变筛査,分析评估结直肠癌的高风险率、依从性和检出率。［结果］ 2014—2019年共对103 229名居民进行危险因素调查,评估出结直肠癌高危人群10 582名,高风险率为10.25%。2735人完成结肠镜筛查,筛查依从性为25.85%(2735/10582)。高风险率和筛查依从性随年龄增加而增大。共有1557名完成病理活检,活检率为56.93%(1557/2735),共检出非瘤性息肉364例,检出率为13.31%(364/2735);非进展期腺瘤1071例,检出率为39.16%(1071/2735);进展期腺瘤114例,检出率为4.17%(114/2735),有随年龄增加而检出率升高的趋势;癌8例(包括早癌6例),检出率为0.29%(8/2735),另有癌前病变819例,早诊率为99.75%（825/827）。结直肠筛查依从性逐年提升。［结论］ 城市癌症早诊早治项目是实现肿瘤“早发现、早诊断、早治疗”的有效途径,提高了项目高危人群结直肠癌早诊早治的比例。肿瘤健康宣教有利于提高肿瘤高危人群的“三早意识”（早发现、早诊断、早治疗）,然而,结肠镜筛查的依从性受多方因素影响,除加强宣教外,可探索将肿瘤筛查纳入医保范围。     

浙江省海宁市40~74岁目标人群结直肠癌早诊早治筛查结果分析

[目的]评价海宁市结直肠癌早诊早治筛查效果.[方法]根据《癌症早诊早治项目技术方案》,对40～74岁目标人群采用危险因素量化评估问卷调查和两次大便隐血试验(FOBT)进行初筛,在此基础上,确定结直肠癌高危人群,然后,用电子结肠镜作进一步精筛,对查出的肠道病变进行及时干预.[结果] 2007～2012年海宁市结直肠癌筛查目标人群为322 034人,完成病史问卷调查286 470例,顺应率为88.96％;其中病史阳性16 807例,阳性率为5.87％;两次大便隐血试验461 348份,其中阳性25 928份,阳性率为5.62％.经初筛确定高危人群40 103人需进一步作结肠镜精筛.完成结肠镜检查29 069例,顺应率为72.90％;共检出肠道病变(息肉、腺瘤、癌)7408例,检出率25.48％,其中进展期以上病变1570例.病史阳性占检出病例数的41.10％,FOBT阳性占58.90％,而在205例结直肠癌中FOBT阳性占了91.71％.[结论]结直肠癌筛查成效显著,使无症状的结直肠癌及癌前期病变患者能够实现“三早”,减轻家庭和社会疾病负担.     

癌症早诊早治工作评价指标的探讨

[目的]探讨癌症早诊早治工作的评价指标。[方法]分析2006～2009年卫生部早诊早治项目宫颈癌、食管癌/贲门癌、结直肠癌、肝癌、鼻咽癌及胃癌的筛查和早诊早治数据,提出并定义癌症早诊早治工作的初步评价指标。筛查早诊率,检出率和治疗率为工作绩效指标;早期发现成本系数（early detection cost index,EDCI）为综合评价指标。[结果]宫颈癌、食管癌/贲门癌、结直肠癌、肝癌、鼻咽癌及胃癌6种癌症的诊断性筛查检出率分别为：5.6%、2.4%、3.9%、1.3%、5.5%、1.5%;筛查早诊率分别为：93.5%、82.3%、91.9%、58.2%、60.0%、80.0%;治疗率分别为：90.9%、68.4%、100%、69.1%、80.0%、85.0%;早期发现成本系数分别为：0.22、0.42、0.48、0.80、2.45、1.68。[结论]宫颈癌、结直肠癌及食管癌/贲门癌的早诊早治有良好的效益,应进一步推广。     

山东省肥城市上消化道癌早诊早治项目可持续发展

摘 要：山东省肥城市上消化道癌筛查及早诊早治在癌症防治工作发展过程中走出了“肥城模式”,显著改善肥城市“因癌致贫,因癌返贫”现象,依托癌症早诊早治筛查项目,搭建系统化健康服务管理平台,开启全民健康之路,助力全面小康。     

湖北省2018-2019年城市癌症早诊早治项目筛查结果分析

目的 分析湖北省2018—2019年城市癌症早诊早治项目的筛查情况。方法 汇总整理湖北省2018—2019年城市癌症早诊早治项目评估数据及临床筛查数据,分析高风险率、人群筛查参与率和各癌种阳性检出情况。结果 2018—2019年共计评估39 575人,整体高风险率为47.31%。各癌种高风险率分别为肺癌21.10%,女性乳腺癌19.01%,食管癌9.60%,胃癌13.76%,肝癌11.22%,结直肠癌17.38%。阳性病变检出率分别为:肺部6.13%,女性乳腺20.04%,肝脏6.38%,上消化道0.42%,结直肠5.02%。结论 城市癌症早诊早治项目的联合筛查模式,长远来看有利于降低恶性肿瘤发病率和死亡率。为提高项目筛查效果,需进一步提高人群的防癌意识,提高50~64岁年龄段人群的筛查顺应性。     

中国结直肠癌筛查与早诊早治指南（2020，北京）

摘 要：结直肠癌是威胁我国居民生命健康的主要癌症之一,造成了严重的社会负担。大量研究和实践表明,结直肠癌筛查与早诊早治是降低人群结直肠癌死亡率的有效措施。参考国际指南制定标准制定符合我国国情的结直肠癌筛查与早诊早治指南势在必行。本指南由国家癌症中心发起,联合多学科专家,采用世界卫生组织推荐的指南制定原则和方法,针对结直肠癌筛查与早诊早治相关专业人员所关注的13个临床问题,给出了详细的循证推荐,旨在规范结直肠癌筛查与早诊早治实践,提升我国结直肠癌防控效果。     

筑牢基层防癌阵线 惠及百姓砥砺前行

摘 要：磁县肿瘤防治工作走过了48年,从基层肿瘤登记及肿瘤流行病学调查逐步发展为集防、治、研为一体的综合防治体系。肿瘤登记跃上国际舞台,成为国际癌症登记协会（IACR）会员;扩建肿瘤专科医院,解决当地癌症患者就诊实际问题,惠及当地百姓健康;承担了国家多项重大科研课题,积极实施癌症“三早”,持续开展高危人群上消化道癌筛查及早诊早治工作,成为全国“肿瘤登记示范中心”和首批“食管癌早诊早治示范基地” “上消化道癌早诊早治示范基地”。为降低食管癌、胃癌发病率和死亡率,提高患者生存率,积极落实筛查及早诊早治,加强防治结合,筑牢基层防癌阵线,以全民健康助力全面小康。     

黑龙江省2013—2014年度城市癌症筛查分析

目的 评价2013—2014年度黑龙江省城市癌症早诊早治项目筛查结果 的意义。方法 在黑龙江省哈尔滨市和大庆市常住人口中,通过危险因素问卷调查评估出高危人群,分别进行相应的临床筛查(肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌),探讨黑龙江省癌症早诊早治的防治效果。结果 2013—2014年度黑龙江省城市癌症早诊早治项目工作,共邀请了15628人参加临床筛查,临床筛查高危人群10299人次,共筛查出66例疑似癌症病例。结论 黑龙江省顺利的完成了2013—2014年度城市癌症早诊早治项目,早诊早治项目可以做到早发现、早诊断和早治疗的目的,对于提高检出癌症患者的生存时间和生存质量具有重要的意义,此项目也为黑龙江省在癌症早诊早治方面的工作积累了经验。     

信息化平台助推癌症筛查和早诊早治管理精准化探索

摘 要：我国癌症筛查和早诊早治工作蓬勃发展，取得显著成绩的同时也存在信息不对称、医生能力不均衡、阳性人员追踪不到位、资源分配不科学等问题。推进癌症筛查和早诊早治管理精准化，就要对项目进行全流程、全周期、全方位的精准化管理，要做到精准识别、精准传递、精准追踪、精准供给来提升癌症筛查和早诊早治的工作质量。北京市将信息化管理平台投入到癌症筛查和早诊早治工作中，实现了癌症筛查和早诊早治信息的区域化管理，基本形成癌症筛查和早诊早治工作信息数字化、资源网络化、服务智能化、监管一体化的服务体系，具有较好的应用性及推广价值。     

The use of distraction and imagery with children during painful procedures

The effectiveness of a paediatric pain management programme was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents'anxiety and behavioural stress. Fourteen people were videotaped while receiving lumbar punctures during an 8–12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behaviour and child pain ratings were obtained at all three visits. The children's behavioural responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.     

食管癌贲门癌切除术后器械吻合口早期隐性瘘的诊治分析(附1例典型病例分析)

目的:探讨食管癌贲门癌切除术后器械吻合口早期隐性瘘的预防及诊治要点。方法:回顾分析西安交通大学第一附属医院2006年9月至2007年8月应用管状消化道吻合器对226例食管癌贲门癌切除后行胸内、腹腔内机械吻合,总结器械吻合口早期隐性瘘的诊治体会。结果:器械吻合口早期隐性瘘的发生与多种因素相关。结论:熟练掌握吻合性能和吻合技术是预防器械吻合口早期隐性瘘的关键。早期发现、早期治疗是处理的关键。     

中国与美国恶性肿瘤的现状比较及差异分析

恶性肿瘤是当今世界最主要的死亡原因之一,但不同国家的不同肿瘤在性别、年龄、地区分布的发病率和死亡率有着显著差异。中美两国作为世界上最大的发展中和发达国家,恶性肿瘤的现状也有所不同,但却存在着许多共性和潜在的相似点。因此,本文目的在于尝试对中美两国最新恶性肿瘤现状相关研究资料进行对比分析探究其中差异,以期为中国在恶性肿瘤的预防、筛查及诊疗方面提供些许借鉴和指导。     

X线立体定向治疗靶点位置精确度分析

目的 :分析影响人头模和实际患者靶点位置精确度的各种因素 ,确定立体定向治疗全过程靶点位置精确度及每一步骤的贡献量。材料与方法 :靶点模拟器设定靶点位置 ,测量靶点计划定位精确度 ;钢珠放置Alderson标准人头模中模似患者治疗 ,测量治疗全过程靶点位置精确度。结果 :CT定位精确度 1 .4± 0 .3mm ,人头模治疗总的精确度为 1 .72± 0 .60mm。结论 :由于有更多的因素影响患者治疗 ,人头模靶点位置精确度是理想情况患者治疗精确度     

Phase I dose escalation study of bortezomib in combination with lenalidomide in patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)

We conducted a phase I dose escalation study to determine the maximal tolerated dose of bortezomib that could be combined with standard dose lenalidomide in patients with MDS or AML. Treatment consisted of bortezomib (IV) on Days 1, 4, 8, and 11 and lenalidomide 10 mg daily (PO) days 1–21 in 28 day cycles for up to 9 cycles. 23 patients (14 MDS/CMML, 9 AML) were enrolled. The maximally tested dose of bortezomib, 1.3 mg/m², was tolerable in this regimen. Responses were seen in patients with MDS and AML. Further testing of this regimen is planned.     

The importance of thermotolerance for the clinical treatment with hyperthermia

Thermotolerance (i.e. a temporary heat resistance following a prior heat treatment) is a general phenomenon occurring in both normal tissues and tumours. Besides affecting a fractionated heat treatment, thermotolerance may also influence the effect of fractionated combined heat and radiation. The importance of thermotolerance for fractionated clinical hyperthermia is discussed on the basis of a series of in vitro experiments in L1A2 cells and in vivo studies of a C₃H mouse mammary carcinoma.If maximal tumour interaction is wanted, thermotolerance should be avoided, but it would be preferable in normal tissues in order to reduce the amount of damage. Unfortunately, there is a considerable variation in the kinetics and magnitude of thermotolerance between different tissues, and it is currently not possible to predict how thermotolerance will develop in a given tumour or normal tissue. However, both the magnitude and the kinetics appear to depend on the heat damage induced by the priming heat treatment. Thus, in a given tissue, thermotolerance will develop later, but will reach a higher maximum by a larger priming heat treatment. It follows that if a homogeneous temperature cannot be applied to a given tissue, different parts will develop thermotolerance at different kinetic patterns. Therefore, at the time of subsequent heat treament, the tissue may express different heat sensitivities in different areas. With the current knowledge, the best way to overcome the problems of thermotolerance when heat is given alone or sequentially with radiotherapy will be by application of a single or few, but large heat fractions given with an interval that allows thermotolerance to develop and decay before the next hyperthermic treatment is given. With a simultaneous heat and radiation treatment which optimally requires heating in association with all radiation fractions, the fractionation interval should also be long, which is complicated by the fact that such long fractionation intervals may not result in an optimal radiation treatment.     

不同年龄成年人急性白血病形态学、免疫学及细胞遗传学分型比较

Objective To investigate the characters of morphology,immunology and cytogenetics of adult acute leukemia (AL) in different ages. Methods 172 cases of newly diagnosed adult AL were divided into two groups:the non-aged group (age＜60 years) and the aged group ( age≥60 years). Morphology,immunology and cytogenetics between the two groups were compared. Results The incidence of M3 in aged AL was significantly lower than that in non-aged AL[6.0 %(3/50) vs 18.9 %(23/122),P ＜0.05]. The incidence of hypo-or extremely hypo-cellular AL in aged AL was significantly higher than that in non-aged AL[14.0 %(7/50) vs 4.1 %(5/122),P ＜0.05],but the incidence of hyper-or extremely hyper-cellular was significantly lower than that in non-aged AL[52.0 %(26/50) vs 73.8 %(90/122),P ＜0.05]. Among aged acute myeloid leukemia (AML),the incidence of lymphoid antigen positive AML (Ly+AML) was significantly higher than that in non-aged AML[63.4 %(26/41) vs 41.3 %(38/92),P ＜0.05]. The incidence of adverse karyotypes in aged AML was significantly higher than that in non-aged AML[33.3 %(11/33) vs 14.1 %(10/71),P ＜0.05].Conclusion Age is an important prognostic factor in AL. Generally,aged AL has poorer prognosis than nonaged AL.     

不同年龄成年人急性白血病形态学、免疫学及细胞遗传学分型比较

Objective To investigate the characters of morphology,immunology and cytogenetics of adult acute leukemia (AL) in different ages. Methods 172 cases of newly diagnosed adult AL were divided into two groups:the non-aged group (age＜60 years) and the aged group ( age≥60 years). Morphology,immunology and cytogenetics between the two groups were compared. Results The incidence of M3 in aged AL was significantly lower than that in non-aged AL[6.0 %(3/50) vs 18.9 %(23/122),P ＜0.05]. The incidence of hypo-or extremely hypo-cellular AL in aged AL was significantly higher than that in non-aged AL[14.0 %(7/50) vs 4.1 %(5/122),P ＜0.05],but the incidence of hyper-or extremely hyper-cellular was significantly lower than that in non-aged AL[52.0 %(26/50) vs 73.8 %(90/122),P ＜0.05]. Among aged acute myeloid leukemia (AML),the incidence of lymphoid antigen positive AML (Ly+AML) was significantly higher than that in non-aged AML[63.4 %(26/41) vs 41.3 %(38/92),P ＜0.05]. The incidence of adverse karyotypes in aged AML was significantly higher than that in non-aged AML[33.3 %(11/33) vs 14.1 %(10/71),P ＜0.05].Conclusion Age is an important prognostic factor in AL. Generally,aged AL has poorer prognosis than nonaged AL.     

Current status of the infrastructure and characteristics of radiation oncology in Korea

BACKGROUND: An analysis of radiotherapy infrastructure in Korea was performed in 2006 to collect data on treatment devices, the work force and new patients for future development plans. METHODS: The survey included radiotherapy centers, their major equipment and personnel. The centers were categorized into four levels: level 0 (stand-alone teletherapy units); level 1 (teletherapy, brachytherapy, treatment planning system, and at least the part-time service of a medical physicist); level 2 (level 1 plus individual customized radiotherapy block and full-time medical physicist); and level 3 [level 2 plus intensity-modulated radiation therapy (IMRT), intra-operative radiation therapy or stereotactic radiotherapy]. RESULTS: A total of 61 facilities delivered radiation therapy with 104 megavoltage devices, which included 96 linear accelerators, two cobalt 60 units, three Tomotherapy, two CyberKnife units and one proton accelerator. There were 28,789 new radiotherapy patients in 2004. Personnel included 132 radiation oncologists, 50 radiation oncology residents, 64 physicists, 130 nurses and 369 radiation therapy technologists. Thirty-two percent (20 facilities) used a CT-simulator, 66% (40) used a PET or PET-CT scanner, and 35% (22) had the capacity to implement IMRT. Centers were also divided into four levels: 41% were included in level 3, 31% in level 2, 25% in level 1 and 3% in level 0. CONCLUSIONS: There is a shortage of human resources. The distribution of megavoltage units per million inhabitants over the country was inadequate; geographic disparities were noted. Furthermore, the necessity of quality assurance for recent high-technology radiation therapy is increasing.