中国结直肠癌人群筛查方案的应用价值初探

目的 评价现行结直肠癌筛查方案的肿瘤检出率,探讨方案的应用价值.方法 筛查目标为2007-2009年杭州下城区和嘉善县40~74岁户籍人口,共43 713名.先进行由问卷调查与大便潜血检测组成的初筛,阳性者进行结肠镜诊断性复筛,发现息肉样病变即取活检或摘除,病理确诊.分析筛查数据,计算初筛阳性人群(高危人群)中不同年龄段和不同性别人群的肿瘤检出率.结果 初筛认定结直肠癌高危人群6489名,占14.85%.共有完成结肠镜检查4701名,检出结直肠肿瘤569例,检出率为12.10%(95%CI:11.17%～13.04%).其中结直肠癌52例,检出率1.11% (95%CI:0.81%～1.41%);进展期腺瘤(183 例)和非进展期腺瘤(334例)检出率分别为3.89%(95%CI:3.34%～4.45%)和7.10%(95%CI:6.37%～7.84%).70～74岁男性肿瘤检出率最高,为22.81%(95%CI:16.98%～28.70%);40～44岁女性中检出率最低,为2.49%(95%CI:0.79%～4.20%).结论 我国现行结直肠癌人群筛查方案的应用效果较好,但方案仍需进一步完善.

Abstract：

Objective To evaluate a colorectal cancer screening program by tumor detection rate and discussing its application values.Method In total,43 713 subjects were recruited in the screening program who were the registered people aged 40-74 in Xiacheng and Jiashan during year 2007-2009.The first screening involved questionnaire survey of colorectal cancer related risk factors and fecal occult blood test (FOBT),colonoscopy was performed when a positive result was observed in the first screening.If polyps were found during colonoscopy,biopsy and pathological diagnosis were carried out.The screening data were analyzed and the tumor detection rate was calculated according to age or sex.Results 6489 subjects (14.85%) belonged to the high risk group of colorectal cancer in the first screening,in which 4701 subjects finished complete colonoscopy.Finally,569 colorectal neoplasm were diagnosed,the detection rate was 12.10% (95%CI:11.17%-13.04%).It included 52 colorectal cancer (1.11%,95%CI:0.81%-1.41%),183 advanced adenoma(3.89%,95%CI: 3.34%-4.45%),334 non-advanced adenoma (7.10%,95%CI: 6.37%-7.84%).The highest detective rate was observed in male group that aged 70-74 (22.81%,95%CI: 16.98%-28.70%),the lowest detective rate was observed in female group aged 40-44 (2.49%,95%CI: 0.79%-4.20%).Conclusion The current colorectal cancer screening program in China works well,but the revision of the program is necessary.

Primary evaluation of a mass screening program for colorectal tumor in China

Objective To evaluate a colorectal cancer screening program by tumor detection rate and discussing its application values.Method In total,43 713 subjects were recruited in the screening program who were the registered people aged 40-74 in Xiacheng and Jiashan during year 2007-2009.The first screening involved questionnaire survey of colorectal cancer related risk factors and fecal occult blood test (FOBT),colonoscopy was performed when a positive result was observed in the first screening.If polyps were found during colonoscopy,biopsy and pathological diagnosis were carried out.The screening data were analyzed and the tumor detection rate was calculated according to age or sex.Results 6489 subjects (14.85%) belonged to the high risk group of colorectal cancer in the first screening,in which 4701 subjects finished complete colonoscopy.Finally,569 colorectal neoplasm were diagnosed,the detection rate was 12.10% (95%CI:11.17%-13.04%).It included 52 colorectal cancer (1.11%,95%CI:0.81%-1.41%),183 advanced adenoma(3.89%,95%CI: 3.34%-4.45%),334 non-advanced adenoma (7.10%,95%CI: 6.37%-7.84%).The highest detective rate was observed in male group that aged 70-74 (22.81%,95%CI: 16.98%-28.70%),the lowest detective rate was observed in female group aged 40-44 (2.49%,95%CI: 0.79%-4.20%).Conclusion The current colorectal cancer screening program in China works well,but the revision of the program is necessary.