鼻咽癌的筛查问题

据本院卢泰祥对1999年本院初治鼻咽癌1333例分析，按1992年制定的分期标准Ⅰ期占13．6％、Ⅱ期30．5％，均比10年前有所提高。本院上世纪80年代中后期经CT检查的421例资料，按92分期Ⅰ期占4．8％、Ⅱ期25．2％，尽管如此，晚期病例仍占多数。早期诊断(下称早诊)率有所提高的原因是多     

门诊病人VCA/IgA与鼻毛隐血筛查鼻咽癌的初步分析

对1999年1月至2000年12月专科门诊病人，用EBV与鼻前庭隐血法筛查鼻咽癌进行分析。认为两项检查均可在门诊作为鼻咽癌筛查和辅助诊断。     

癌症筛查成本效果评估的研究进展

癌症是严重威胁人类生命和健康的疾病之一,已成为全球性的公共卫生问题.癌症筛查是肿瘤二级预防的主要手段,能够早期发现癌症,提高患者生活质量、延长生存期.但是,由于筛查成本相对较高,进行成本效果评估就显得尤为重要.全文通过检索国内外相关文献,搜索政府和机关网站,对目前公认适合筛查的官颈癌、结直肠癌和乳腺癌,以及尚未推荐筛查的肺癌、肝癌、食管癌、前列腺癌、甲状腺癌的卫生经济学评估研究进行了系统回顾和总结.     

鼻咽癌高癌家族的监控和筛查

目的：通过对高癌家族成员的有效监控,探索筛查无明显症状的早期鼻咽癌病人的方法,以提高鼻咽癌早期发现、早期诊断和早期治疗。方法：选择在两代人中有３个以上鼻咽癌患者的“高癌家系”作为本组“监控家系”,对其有血缘关系的亲属（１～３级亲属）共１２１人作为本组的监控对象,对他们进行详细的鼻咽及头颈部临床检查、ＥＢ病毒血清学抗体检测、血标本作基因定位检测。定期（约６个月）进行追踪复查,对有可疑患癌者即作鼻咽光     

鼻咽癌两种放射治疗方案的成本效果分析

目的:分析常规放疗和调强放疗方案治疗鼻咽癌(NPC)的成本与效果。方法:分别采用常规放疗和调强放疗方案,对546例NPC患者进行放射治疗。计算各组患者的成本、完全缓解率以及成本效果比(C/E)、增量成本效果比(△C/△E)。结果:1)成本:Ⅰ+Ⅱ期、Ⅲ期和Ⅳ期调强组成本显著高于常规组,P均<0.01。2)效果:调强组Ⅰ+Ⅱ期、Ⅲ期和Ⅳ期完全缓解率分别为92.86%、91.67%和76.00%,常规组Ⅰ+Ⅱ期、Ⅲ期和Ⅳ期完全缓解率分别为68.48%、58.05%和50.77%。各期内调强组完全缓解率均显著高于常规组,P均<0.01。3)成本-效果:Ⅰ+Ⅱ期,调强组C/E(600.60)高于常规组(360.80);Ⅲ期,调强组C/E(711.88)高于常规组(442.59);Ⅳ期,调强组C/E(881.66)高于常规组(512.61)。△C/△E(以成本较低的常规组作为参照)分别为Ⅰ+Ⅱ期1 274.16、Ⅲ期1 176.87、Ⅳ期1 624.29。结论:常规放疗方案在费用控制方面占优势,但调强放疗效果远好于常规放疗,建议经济状况允许的患者选择调强放疗方案。     

河北省食管癌高发现场内镜筛查成本效果评价

[目的]拟从经济学角度对食管癌高发现场内镜筛查进行初步评价．为其大范围推广和实施提供科学依据。[方法]对2002年在食管癌高发现场河北省磁县实施的内镜筛查成本进行调查,对干预组和对照组5年全死因和恶性肿瘤发病进行监测和随访。[结果]实施内镜筛查5年后,干预组食管癌累积发病率（729．4／10万）,低于对照组（482．2／10万）51.3％;干预组食管癌累积死亡率（753．9／10万）低于对照组（412．2／10万）82．93％。平均每筛查1例原位癌以上患者需要3107元,每筛查1例食管癌患者需要14206元。从筛查成本看．每少发生1例食管癌需要6255．7元,每少1例食管癌死亡需要4526．3元。[结论]在中国食管癌高发区进行内镜筛查干预是可行的．具有良好的绩效。     

鼻咽癌调强放疗初步结果

目的:探讨鼻咽癌三维适形调强放射治疗(intensity-modulatedradiotherapy,IMRT)的初步疗效。方法:对91例经病理确诊的鼻咽低分化鳞癌患者进行调强放疗。处方剂量分别为GTV(鼻咽部和颈部淋巴结肿瘤靶区)66~70Gy,CTV1(临床靶区)60~62Gy,CTV2和CTVn(颈部淋巴结区域)54~56Gy。11例患者IMRT结束后有局部残留,1例采用IMRT追量照射10Gy/4次,其余给予鼻咽腔内后装追量照射9~15Gy/3~5次。分析疗效及放射治疗毒性。结果:中位随访时间12个月,1和2年生存率为97·1%和97·1%,局控率为97·1%和92·5%。急性放射反应多为Ⅰ度和Ⅱ度以口干和放射性口腔炎为主,分别占72·5%和58·2%。远期放射反应表现为不同程度的口干和听力下降,占患者的39·6%和17·6%。GTV、CTV1及CTV2的平均剂量分别为70·6、67·9和65·0Gy;5%体积的正常器官受照射剂量的平均值为:脑干41·4Gy,脊髓35·4Gy,左腮腺46·5Gy,右腮腺51·8Gy。结论:调强放疗能使得鼻咽癌各靶区得到很好的剂量分布,提高了初治鼻咽癌的局部控制率,明显减轻了急性放射反应。鼻咽癌IMRT处方剂量70Gy以上,CTV2预防照射的范围有待于进一步探讨。     

广州市越秀区大肠癌筛查成本效益分析

摘 要：［目的］ 依据广州市越秀区2011~2013年的大肠癌筛查数据,分析大肠癌筛查的经济效益和社会效益,为大肠癌筛查的推广提供理论依据。［方法］ 测定大肠癌筛查的直接成本、直接效益和间接效益,计算筛查成本效果、净效益和效益成本比。［结果］ 平均初筛1人的成本为25.17元,复筛1人的成本为290.00元,确定1例高危人群成本为62.94元,确诊1例腺瘤性病变的成本为2313.14元,确定1例大肠癌的平均成本需63380.00元;筛查可获益448.54万元,效益成本比为3.63。［结论］大肠癌筛查可降低医疗成本,提高早诊早治率,有一定意义。     

大肠癌筛查的成本测算及成本控制

[目的]探讨大肠癌筛查的成本测算,为筛查工作的成本控制提供依据。[方法]分析嘉善县大肠癌筛查的成本并进行测算和统计分析。[结果]初筛的依从性为84.6%,精筛的依从性为78.7%,平均初筛1例成本为27.2元,每确定1例高危人群平均成本为180.5元,每确诊1例大肠癌平均成本为42963.3元,每确诊1例大肠腺瘤平均成本为4384.0元,每减少1例大肠癌的平均成本为12768元。[结论]从成本与效益分析大肠癌高发区筛查是有益的,合理控制成本可提高效益。     

宫颈细胞学和HR-HPV检测筛查宫颈病变的成本效果分析

目的:探讨宫颈细胞学和高危型人乳头瘤病毒(HR-HPV)检测筛查宫颈病变的卫生经济学指标,为预防措施的经济效果评价提供依据.方法:对北京地区6 185名已婚妇女采用宫颈液基薄层细胞学(TCT)和TCT联合HR-HPV检测进行宫颈病变流行病学调查,对比分析不同筛查试验的病理学诊断指标,并利用成本-效果分析(CEA)不同筛查方法结局.结果:1)北京地区已婚妇女宫颈细胞学异常的发生率为9.73％,病理结局为宫颈上皮内瘤变(CIN)的构成比为61.79％.其中,宫颈低度病变为79.30％,高度病变为20.16％,镜下早期浸润癌为0.54％.宫颈细胞学异常合并HR-HPV感染阳性人群中病理诊断为CIN的构成比为75.40％.其中,宫颈低度病变为62.57％,高度病变为35.29％,镜下早期浸润癌为2.14％.两种筛查方法病理结局为CIN的构成比比较,诊断宫颈病变差异有统计学意义,P＜0.05;诊断宫颈高度病变方面,差异有统计学意义,P＜0.05.2)宫颈癌筛查人群以30～44岁年龄阶段为筛查的最佳人群.3)细胞学联合HR-HPV筛查组每筛查出1例组织病理CIN阳性患者平均成本为7041.47元,而细胞学筛查组为3 131.89元.前者为后者的2.24倍.相同年龄阶段TCT筛查组和TCT+ HPV筛查组的成本-效果比较,差异有统计学意义,P＜0.01.结论:细胞学检查在筛查宫颈病变方法上具有明显的卫生经济学优势,可以作为宫颈病变的初筛方法.对细胞学检查异常者,HR-HPV检测可以作为诊断CIN的分流措施.这种措施对年龄在30～44岁的人群意义尤为重要.     

早期发现和筛选鼻咽癌的EB病毒血清学检测

鼻咽癌是中国人,特别是中国南方人的一种常见癌症;世界上除其他少数族群具有中等程度的发病率以外,它是一种罕见的癌症。鼻咽癌多见于男性,男女发病率之比约为3∶1,且好发于中年人。现今已有令人信服的证据,支持EB病毒(国际癌症研究协会归属为第一类人体肿瘤病毒)是鼻咽癌的致病因子,肯定参与鼻咽癌的多阶段、多因素发生过程。本文简要地复阅了EB病毒在鼻咽癌发病机理中的作用,重点地介绍了EB病毒抗体和EB病毒DNA作为鼻咽癌标志的主要应用;根据由鼻咽癌导致的EB病毒抗体反应的现代知识,并考虑到目前可采用的检测技术,提出了促进有效地早期发现鼻咽癌的血清学筛选策略。     

鼻咽癌人源抗独特型单链抗体的制备及筛选

背景与目的:抗独特型抗体作为肿瘤抗原替代物可用于肿瘤治疗,这已在临床试验中得到证实。但由于目前所使用的抗独特型抗体多为鼠源性,用于人体可产生人抗鼠抗体反应,从而影响疗效。本实验拟构建噬菌体人源抗独特型抗体库,并从中筛选出能模拟鼻咽癌相关抗原的β型抗独特型单链抗体scFv(Ab2βscFv),以解决鼠源性抗独特型抗体用于临床所产生的人抗鼠抗体反应。方法:体外致敏并用EB病毒(Epstein-Barrvirus,EBV)转化鼻咽癌患者的外周血单个核细胞(peripheralbloodmononuclearcell,PBMC),用RT-PCR分别扩增VH和VL基因并连接成scFv基因,将scFv基因与载体fUSE5连接后,转化大肠杆菌MC1061,构建噬菌体呈现型scFv库。在用单抗FC2对文库进行4轮筛选后,用SandwichELISA和结合抑制法从中筛选出β型Ab2scFv。结果:用单抗FC2体外致敏并经EBV转化的10例鼻咽癌患者的PBMC中,8例有鼻咽癌抗独特型抗体产生。经PCR分别扩增出5种VH(γ、μ)和7种VL(κ、λ)基因,经连接组成14种scFv基因。在与载体连接后,导入大肠杆菌MC1061,得到库容为1.5×108的初级噬菌体抗独特型抗体库。经富集筛选后,从中随机挑取270个克隆进行ELISA筛选,得到91个Ab2scFv单克隆,阳性率为33.7%。再用结合抑制法从中初步筛选出5个可能为β型的Ab2scFv。结论:联     

Detection of Stage I nasopharyngeal carcinoma by serologic screening and clinical examination

In a prospective study, 42 048 adults residing in Zhongshan City, Guangdong, China, were followed for 16 years, and 171 of them developed nasopharyngeal carcinoma (NPC). Although Epstein-Barr virus (EBV) antibody levels of the cohort fluctuated, the antibody levels of 93% of the patients with NPC were raised and maintained at high levels for up to 10 years prior to diagnosis. This suggests that the serologic window affords an opportunity to monitor tumor progression during the preclinical stage of NPC devel...     

Cost-effectiveness of screening for common cancers

Consideration of cost-effectiveness has guided public and insurers' decisions about preventive services for almost 20 years. Legislative decisions on coverage of specific cancer screening tests under Medicare and Medicaid have traditionally followed studies of their cost-effectiveness. This paper reviews the principles of cost-effectiveness analysis in health care. Cost-effectiveness analysis is a stylized form of investment analysis, where the returns on the investment are measured in improvements in health rather than in dollars and consider society as a whole as the relevant investor. Cost-effectiveness studies of screening for two common cancers, cervical and colorectal, illustrate the strengths and weaknesses of cost-effectiveness analysis. Dependence on models of the disease process, which may be sketchy, and uncertainty about costs and benefits of screening are inherent in the methodology. Although economic evaluations of both cervical and colorectal cancer screening have found them to be relatively cost-effective compared with doing nothing, such studies have not resolved the uncertainty about the best screening strategy for either disease. With cervical cancer, new evidence about the relationship between human papilloma virus and high-grade neoplasia suggests the need for new models of the disease process that can support additional cost-effectiveness analyses. Colorectal cancer screening models must be validated against new information from recent randomized clinical trials. Despite uncertainty and contradictions in existing studies of screening for both diseases, investment models force clinicians and decision-makers to consider all important consequences for health care costs and outcomes.     

Familial nasopharyngeal carcinoma in Hong Kong: epidemiology and implication in screening

The pathogenetic mechanism of nasopharyngeal carcinoma (NPC) is still unclear. Its familial aggregation, on the other hand, has been well documented by many epidemiological studies. The objective of this study was to evaluate the clinical characteristics of familial NPC in an endemic region. Between March 1994 and November 2005, 1,202 consecutive patients were treated at our institution. Patients were divided into 2 groups according to their family history: group 1 had at least one first-degree relative with NPC at the time of diagnosis, and group 2 did not. There were 125(10.4%) patients in group 1, 66% of them had diseased siblings, 44% had diseased parents and 2% had diseased offspring. The patients in group 1 were on average about 2 years younger than group 2 at diagnosis (47.9 vs. 49.8, P = 0.04). There were also more stage I–II patients in group 1 (37 vs. 23%, P < 0.01). Although the 5 year overall survival was also higher with group 1 (79 vs. 69%, P < 0.01), only age, sex, T classification and N classification were found to be significant independent factors but not family history per se (P = 0.10). Similar findings were observed after excluding screen-detected patients from group 1. The high incidence of familial clustering and improved outcomes from early detection highlight the importance of screening among these high risk family members. Accepted for poster presentation at the World Cancer Congress of International Union Against Cancer 2008. An erratum to this article can be found at     

Cost-effectiveness of cervical cancer screening: comparison of screening policies

BACKGROUND: Recommended screening policies for cervical cancer differ widely among countries with respect to targeted age range, screening interval, and total number of scheduled screening examinations (i.e., Pap smears). We compared the efficiency of cervical cancer-screening programs by performing a cost-effectiveness analysis of cervical cancer-screening policies from high-income countries. METHODS: We used the microsimulation screening analysis (MISCAN) program to model and determine the costs and effects of almost 500 screening policies, some fictitious and some actual (i.e., recommended by national guidelines). The costs (in U.S. dollars) and effects (in years of life gained) were compared for each policy to identify the most efficient policies. RESULTS: There were 15 efficient screening policies (i.e., no alternative policy exists that results in more life-years gained for lower costs). For these policies, which considered two to 40 total scheduled examinations, the age range expanded gradually from 40-52 years to 20-80 years as the screening interval decreased from 12 to 1.5 years. For the efficient policies, the predicted gain in life expectancy ranged from 11.6 to 32.4 days, compared with a gain of 46 days if cervical cancer mortality were eliminated entirely. The average cost-effectiveness ratios increased from $6700 (for the longest screening interval) to $23 900 per life-year gained. For some countries, the recommended screening policies were close to efficient, but the cost-effectiveness could be improved by reducing the number of scheduled examinations, starting them at later ages, or lengthening the screening interval. CONCLUSIONS: The basis for the diversity in the screening policies among high-income countries does not appear to relate to the screening policies' cost-effectiveness ratios, which are highly sensitive to the number of Pap smears offered during a lifetime.     

Outcomes of nasopharyngeal carcinoma screening for high risk family members in Hong Kong

We undertook a large retrospective study to evaluate the impact of screening family members of NPC patients with Epstein Barr Virus (EBV) serology. 1,199 asymptomatic family members of NPC patients were entered into the annual screening program with EBV serology and nasopharyngoscopy between 1994 and 2005. Eighteen participants of our screening program developed NPC; 17 of them were treated in our institute, of whom 16 were detected in screening. The sensitivity and specificity of EBV serology were 83.3 and 87.0%, respectively, and for the program they were 88.9 and 87.0%, respectively. Stage distributions and survival outcomes of the 17 cases were compared with that of 1,185 consecutive symptomatic patients diagnosed in the same period through general referral. It was found that the screening program resulted in early detection of cancer, with 59% presenting at early stage (stage I: 41%, stage II: 18%) compared to 24% (stage I: < 1%, stage II: 23%) of symptomatic cancers (P < 0.001), and a significant improvement in disease-free survival (P = 0.04). The cancer specific survival and overall survival rate at 5-year are also higher (92 vs. 77% and 92 vs. 70%, respectively), though they fail to reach statistical significance. In conclusion, screening asymptomatic family members of NPC patients annually leads to earlier detection of NPC and clinically valuable survival advantage among these family members. A larger sample size is needed to confirm its full potential in survival benefit.