磁县食管癌高发区贲门癌及其癌前病变检出率分析

[目的]探讨磁县食管癌高发区居民贲门癌及其癌前病变的分布情况。[方法]回顾整理磁县2005~2009年40~69岁高危人群的内镜筛查资料,按性别,年龄统计贲门癌及其癌前病变的检出率。[结果]纳入分析普查对象11 423人,贲门活检率95.71%。贲门低级别上皮内肿瘤检出率为2.07%,高级别上皮内肿瘤为0.30%,黏膜内腺癌为0.23%、浸润性腺癌为0.18%。各级别病变检出率男性均高于女性,并且随年龄的增高病变检出率增加。[结论]磁县食管癌高发区40~69岁人群存在无症状贲门癌及其癌前病变的患者,年龄和性别与检出率关系密切。食管癌高发区上消化道癌筛查应重视贲门部位的检查。     

磁县食管癌高发区高危人群食管癌前状态及病变分析

  目的  了解磁县食管癌高发区居民食管癌前状态及病变的分布情况,为该病的病因及二级预防提供依据。   方法  收集磁县2005年1月至2009年12月完成的40~69岁人群的食管癌早诊早治内镜筛查资料,筛查采用内镜碘染色指示性活检,并对符合对象按性别、年龄组统计食管癌癌前状态及病变的检出率。   结果  纳入分析队列筛查对象11 423例,食管活检率66.90%。食管鳞状上皮轻度、中度、重度异型增生检出率分别为11.84%、2.66%、1.04%,原位癌检出率为0.40%,鳞癌可能有浸润的患者检出率为0.04%、黏膜内鳞状细胞癌为0.37%,浸润性鳞癌为0.17%。平均重度异型增生以上及癌的检出率为2.01%。   结论  磁县食管癌高发区40~69岁人群存在大量无症状癌前病变及癌症患者,年龄和性别与检出率关系密切。      

2015—2018年重庆市农村上消化道癌早诊早治项目内镜筛查结果分析

摘 要：［目的］ 分析总结2015—2018年重庆市农村地区上消化道癌（食管癌、贲门癌及胃癌）早诊早治项目内镜筛查结果。［方法］ 选择上消化道癌发病率较高的区县,采取整群抽样的方法,对8236例40~69岁的无症状的人群进行上消化道癌筛查。［结果］ 2015—2018年完成胃镜筛查8236例,活检2810例,共检出重度异型增生、高级别上皮内瘤变及癌71例,检出率为0.86%,其中食管重度异型增生及癌检出率为0.40%（33例）,贲门高级别上皮内瘤变及癌检出率为0.15%（12例）,胃高级别上皮内瘤变及癌检出率为0.32%（26例）;其中早期病例59例,早诊率为83.10%;治疗病例62例,治疗率87.32%。对未治疗的癌前病变以上患者共348例进行随访,成功随访228例,随访率为65.52%,其中随访中新发现病例5例,全为早期病例,并已全部接受治疗。［结论］ 开展上消化道癌筛查,不仅普及了当地群众的肿瘤防治知识,还能及时发现癌前病变及早期癌,并通过适宜的干预手段从而阻断疾病的进行性发展,降低癌症的发病率和死亡率,同时,提高了基层医疗单位及工作人员的癌症防控水平。     

非高发区食管癌筛查人群食管病理分布

摘 要：［目的］探讨非高发区食管癌筛查人群的食管病理分布,评价食管癌筛查检出效果。［方法］采用整群抽样的方法,以食管癌发病率不高于河南省平均发病水平的3个县/市为研究现场,对当地40～69岁居民进行风险问卷评估,对高危人群开展以食管碘染色及指示性活检为技术的食管内镜检查,并对内镜下异常的病变进行病理活检确诊。诊断结果以病理结果为标准。描述不同性别及年龄组人群食管病理分布。［结果］ 参加食管癌内镜筛查人数23 733人,进行活检人数13 679人,活检率57.64%。食管疾病发病率由高到低依次为食管炎性疾病、鳞状上皮轻度异型增生、鳞状上皮中度异型增生、鳞状上皮重度异型增生、食管早期癌、浸润癌。食管各类病变发病率随年龄增长而增加,且在男性人群中发病率均高于女性。内镜活检病理人群中,各类食管异常病理占比39.92%,癌前病变及食管癌占比7.28%,早期癌及以上病变占0.69%。内镜筛查人群中,各类食管异常病理占23.00%,癌前病变及食管癌占4.19%,早期癌及以上病变占0.39%。［结论］ 内镜下碘染色技术用于非高发区人群食管癌筛查,阳性检出率明显低于高发区食管癌筛查检出率。非高发区人群的食管癌筛查策略需要进一步改进。     

食管癌、胃癌均高发地区应用内镜对上消化道癌筛查的探讨

[目的]探讨在食管癌、胃癌均高发地区采用内镜对上消化道癌(食管癌、胃癌)联合筛查的价值.[方法]采用流行病学调查、血清胃蛋白酶原(PG)检测、内镜活检和病理检查同时进行的方法,对武威市凉州区40～69岁无症状,有上消化道病史、食管癌和胃癌家族史志愿者进行上消化道癌筛查.[结果]共筛查2 005人,上消化道癌检出率0.65％(13/2005),其中食管癌0.15％(3/2005),胃癌0.50％(10/2005);早期食管癌检出率100.00％(3/3),早期胃癌检出率30.00％(3/10),进展期胃癌为70.00％ (7/10);食管重度异型增生/原位癌、中度异型增生检出率分别为0.15％ (3/2005)、0.20％ (4/2005);胃高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.20％(4/2005)、12.62％ (253/2005)、10.92％(219/2005)和19.50％(391/2005).以PG Ⅰ≤70ng/ml,PG Ⅰ/Ⅱ≤7.0作为PG单筛胃癌临界值,PG阴性1 280人(63.84％),阳性725人(36.16％);PG阳性者中胃癌检出率0.69％ (5/725),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.28％ (2/725)、16.69％(121/725)、16.00％(116/725)、22.34％(162/725);PG阴性者胃癌检出率0.39％(5/1280),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.16％(2/1280)、10.31％(132/1280)、8.05％(103/1280)、17.89％(229/1280).PG阳性与PG阴性的胃癌及其癌前病变检出率有显著性差异(P＜0.01).PG阴性1 280人中,检出食管癌2例,重度异型增生/原位癌1例;PG阳性725人中,检出食管癌1例,重度异型增生/原位癌2例.[结论]在食管癌、胃癌高发区直接应用内镜对上消化道癌进行筛查,能最大限度降低上消化道癌的漏诊,使设备、技术、经费及卫生资源得到充分利用.     

食管癌高发区食管和贲门癌前病变和早期癌患病特征分析

[目的]探讨食管癌高发区食管和贲门高级别上皮内瘤变及早期浸润癌的患病特点。[方法]选择4078例内镜碘染色筛查的40～69岁的队列人群为样本。根据WHO 2000年消化道肿瘤病理诊断标准,食管高级别内瘤变（HIN）包括重度不典型增生和原位癌,贲门高级别内瘤变（HIN）指重度不典型增生和黏膜内癌;以中国成人体质指数（BMI）分类指南,将BMI 18.5～23.9为正常组、〈18.5为体重过低,24.0～27.9为超重,≥28.0为肥胖,分析食管与贲门的患病特点。[结果]内镜碘染色筛查食管HIN患病率3.04%,贲门HIN0.76%,食管与贲门患病比4.00;患病平均年龄分别为53.9±0.69岁和55.0±1.28岁,P=0.514。早期浸润性食管癌患病率0.69%,贲门癌0.42%,患病比值1.65;患病平均年龄分别为56.6±1.23岁和62.2±6.00岁,P=0.006。食管和贲门的HIN在BMI正常切点分别占59.7%和77.4%,早期浸润癌为71.4%和76.5%,两组病人BMI4个切点总构成均无统计学意义。食管和贲门HIN病例有肿瘤家族遗传背景分别是47.6%和48.4%;浸润癌病例分别是67.9%、70.6%,但均无统计学差异。[结论]内镜碘染色筛查诊断食管HIN和早期浸润癌的敏感性高于贲门;BMI不是食管癌高发区贲门腺癌的主要危险因素;早期浸润性贲门癌的平均患病年龄大于食管癌;食管与贲门的HIN,以及早期浸润癌的肿瘤家族遗传史无差异。     

食管贲门重复癌及重复高级别上皮内瘤变患病队列分析

 目的从经典的重复癌诊断和WHO肿瘤新分类两个标准，分析食管癌高发区食管贲门重复癌和重复高级别上皮内瘤变患病情况。方法选择河北省磁县2013例40-69岁队列人群为样本。根据WHO新分类标准，将食管鳞状上皮的重度不典型增生、原位癌和贲门腺上皮重度不典型增生、粘膜内癌划为高级别上皮内瘤变（HIN）。对食管和贲门病理同时为HIN的作为重复HIN诊断；食管贲门重复癌仍采用Warren标准。结果以Warren的诊断标准统计，食管贲门重复癌患病率为0．01％（2／2013），占食管贲门原位癌、粘膜内癌和早期浸润癌总检出的2．2％（2／88）；重复HIN患病率0．2％（4／2013），占HIN总检出的3．3％（4／123）。结论磁县40-65岁人群食管贲门重复癌和重复HIN患病率相对较高。     

新疆哈萨克族胃癌早期防治适宜技术的研究与应用

[目的]探索一套适宜新疆哈萨克族胃癌筛查和早诊早治适宜技术模式并示范应用.[方法]针对新疆哈萨克族胃癌高发的问题,通过建立哈萨克族胃癌四级医疗合作网络,培训基层医务人员,利用胃癌早期三级筛查方法,以人群为基础开展新疆哈萨克族胃癌的筛查和早期诊断、早期治疗工作.[结果]完成新疆哈萨克族大便潜血试验6012人,受检率为52.28％,隐血珠试验5329人,受检率为46.34％;完成哈萨克族胃镜检查2196例;确诊胃高级别上皮内瘤变3例,早期胃癌2例,中晚期胃癌10例,胃低级别上皮内瘤变13例,哈萨克族胃癌早诊率为33.33％.食管高级别上皮内瘤变2例,早期食管癌2例,中晚期食管癌9例,食管低级别上皮内瘤变11例,食管癌早诊率为30.77％;并对新疆哈萨克族3例胃高级别上皮内瘤变、2例早期胃癌、2例食管高级别上皮内瘤变和2例早期食管癌进行了内镜下黏膜剥离术(ESD)及术后随访.[结论]大便潜血和隐血珠试验作为新疆哈萨克族胃癌初筛的方法并不明显优于胃镜的直接检查;在少数民族高发区,将动员目标人群筛查与人群有症状者主动筛查相结合,对40岁以上人群每3年直接进行胃镜筛查,提高早癌检出率.     

蓝激光内镜联合化学染色与白光内镜对上消化道早癌检出情况对比研究

摘 要：［目的］探究蓝激光内镜联合化学染色对上消化道早癌及癌前病变的诊断价值。［方法］ 回顾性分析2019年1月至2021年12月行胃镜检查的患者6 332例,根据患者所用内镜及检查过程不同分为蓝激光组与白光组,比较两组患者上消化道早癌及高级别上皮内瘤变、低级别上皮内瘤变及癌前状态的检出情况。［结果］ 蓝激光组上消化道癌及高级别上皮内瘤变检出率为1.63%（42/2 576）,高于白光组的0.85%（32/3 756）,差异有统计学意义（χ2=8.017,P=0.005）。蓝激光组低级别上皮内瘤变及癌前状态检出率为41.15%（1 060/2 576）,高于白光组的37.78%（1 419/3 756）,差异有统计学意义（χ2=7.282,P=0.007）。蓝激光组食管、贲门、胃的活检率均高于白光组,差异有统计学意义（χ2=4.069,P=0.044;χ2=4.010,P=0.045;χ2=28.757,P＜0.001）;蓝激光组对癌性病变及高级别上皮内瘤变早诊率高于白光组,差异有统计学意义（χ2=5.367,P=0.021）。［结论］ 蓝激光内镜联合化学染色可以提高活检率,从而提高上消化道早癌及高级别上皮内瘤变、低级别上皮内瘤变及癌前状态的检出率、早诊率,有利于上消化道癌早诊早治项目的推广。     

食管癌高发区人群内镜筛查

[目的]探讨在高发区高危人群中发现早期癌及癌前病变的有效途径。[方法]林州市“食管癌早诊早治示范基地”依据中国癌症基金会对基地高危人群筛查方案．2005～2007年在林州市合涧镇的目标人群中按照顺应性70％的要求,对8432例40～69岁的6048例人群进行了内镜＋食管碘染色＋指示性活检和贲门脊根部活检。[结果]发现癌症患者100例,其中食管癌38例,贲门癌54例,胃癌7例,下咽癌1例．其中早期癌83例．检出率1．65％;癌前病变（高级别上皮内瘤变）148例,检出率2．45％。[结论]提高高危人群对癌症的认知度,推广食管碘染色和贲门脊根部常规活检技术．是提高食管贲门癌早期发现的关键。     

Anaplastic transformation of metastatic follicular carcinoma of the thyroid

This is a case report of a patient believed to be the first reported case of pulmonary metastases from follicular carcinoma of the thyroid undergoing transformation to anaplastic carcinoma proven by serial biopsies.     

Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer

The prognosis of patients with stage III nonsmall cell lung cancer was studied, with special attention to their biologic status prior to lung resection. The biologic status was estimated from the neutrophil/lymphocyte ratio in the peripheral blood, serum albumin level, and erythrocyte sedimentation rate. Among 46 patients who underwent potentially curative operations, 31 cases of biologic status A or B (more than two parameters normal) revealed 37.6% of a 5-year survival rate, whereas there was no 5-year survivor in 15 cases of biologic status C or D (more than two parameters abnormal). Of the 5-year survival rate in T3N0 disease of biologic status A or B, the 60% surviving (of 10 cases) was in marked contrast to the same stage disease of biologic status C or D where only 1 patient (of 10 cases) was still surviving at more than 30 months. In 30 patients with T3N0, T3N1, and T2N2 diseases of biologic status A or B, where long-term survivors were derived, the 5-year survival rate in 30 patients of biologic status A or B was 36.6% in contrast to no long-term survivor in the same stage diseases of biologic status C or D (n = 25). We conclude that surgical results in stage III nonsmall cell lung cancer will be beneficial in patients of biologic status A or B, but nonbeneficial in patients with the same stage of biologic status C or D.     

中国人群肿瘤家族史与鼻咽癌关系Meta分析

目的系统评价中国人群肿瘤家族史及与鼻咽癌之间的关系及相关强度,为我国鼻咽癌的防治策略提供依据。方法系统检索CNKI、万方和维普3个中文数据库及PudMed、ScienceDirect和SpringerLink 3个英文数据库2013-03之前发表的鼻咽癌病例对照研究及队列研究。文献检索、选取、信息提取及质量评价(NOS评分)均由2人独立进行。采用基于方差倒数加权的随机效应模型合并研究结果。结果纳入合格研究文献16篇,鼻咽癌患者7 478例,对照8 456例。肿瘤家族史与鼻咽癌患病的合并OR=2.63,95%CI为1.56~4.01;I2=49.2%,P=0.023;N=13;鼻咽癌家族史与鼻咽癌患病的合并OR=3.12,95%CI为2.47~3.78;I2=0,P=0.700;N=8。结合漏斗图及发表偏倚检验的结果,尚不能排除潜在的发表偏倚对结果的影响。结论在中国,肿瘤家族史,尤其是鼻咽癌家族史,会显著增加鼻咽癌的患病风险。     

Screening for cancer of the head and neck: if not now, when?

There is as yet no evidence to support population screening for oral cancer, although the mouth is easy to examine, and the disease is common in certain parts of the world and/or subsegments of the population. Oral cancer screening programs have been carried out on several hundred thousands of individuals in developing countries (mostly India and Cuba) and several thousands in developed countries (mostly the U.S.A., U.K. and Italy). Especially in developed countries, lesions of the pharynx and larynx were also searched for. Substantial portions of individuals with suspicious lesions (around 10%), mostly leukoplakia, could be identified, but major difficulties were found in targeting highest-risk individuals and referring them to a specialised centre, when necessary. When oral inspection was repeated, relatively high incidence of oral cancer, after removal of prevalent cases, suggested a rather short sojourn time for preclinical cancer (in the order of one year). Oral cancer screening programmes would be greatly facilitated by screening tests able to anticipate the detection of a preclinical phase, compared to visual inspection, thus allowing screening intervals to be prolonged. Finally, even if dysplastic lesions of the oral cavity were better recognised and understood (e.g. as for intraepithelial lesions of the cervix uteri), surgical control of the disease would be harder than for the uterus, breast, or colon-rectum.     

Consistency of self-reported first-degree family history of cancer in a population-based study

The aim of this study was to assess the prevalence and consistency of self-reported family history of cancer among first-degree relatives (FDR) in a population-based study. Women at primary care units (PCU) were submitted to a questionnaire about cancer family history. Consistency of the report was determined by comparing self-reported history at the PCU to data from subsequent genetic evaluations and/or cancer confirmatory documents. Consistency in relation to degree of education, reported tumor type and reported age at cancer diagnosis in FDR was assessed. In 8,881 women interviewed, the prevalence of cancer in an FDR was 25.14% (CI 95%: 24.14; 25.94). Mean age was 40.29 years and most (70.26%) had ≤8 years of education. There was a good agreement of self-reported cancer history at the PCU and in subsequent genetic evaluations [Kappa coefficient = 0.76 (P < 0.05)]. Inconsistencies were not related to low literacy (χ ² = 2.027; P = 0.363). Consistency of the reported information for cancer status, cancer type and age of onset was 92.59%, 85.33% and 92.64%, respectively. The prevalence of cancer history in an FDR was similar to previous reports in other populations. Consistency and reliability of the self-reported information was high, regardless of educational level.     

Analysis of failures following local treatment of isolated local-regional recurrence of breast cancer

Obe hundred fifty-seven patients with local-regional recurrence of breast cancer but without co-existing distant metastases were reviewed. The incidence of failure to control the local-regional recurrence was essentially the same whether the recurrence was treated with radiotherapy alone (62% ), surgery alone (76% ), or with a combination of the two (60 % ). A detailed analysis of the failures occurring in the patients treated with radiotherapy, with or without surgery, showed that most of the failures were because of a) inadequate doses of irradiation, b) the use of fields that were too small, and c) the lack of elective irradiation to the chest wall and supraclavicular fossa. Of the 100 patients with uncontrolled local-regional disease, 62% developed clinical symptoms that markedly impaired the quality of life. All of these symptoms were directly caused by the uncontrolled local-regional disease. Specific recommendations for the treatment of isolated local-regional recurrence are made.