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。

Analysis of the effects of esophageal cancer screening in Henan rural areas with cancer screening program,2014-2018

Objective To analyze the effects of esophageal cancer screening in Henan rural areas with cancer screening program from 2014 to 2018.Methods From July 2014 to June 2019,according to the National Early Diagnosis and Treatment of Upper Gastrointestinal Cancer in Rural Areas Project,cluster sampling method was adopted in 16 counties/county-level cities in rural areas with high incidence of esophageal cancer in Henan province.Endoscopic iodine staining and indicative biopsy were used to screen esophageal cancer.The patients with mild and moderate dysplasia confirmed in screening were followed up.The distribution of esophageal diseases in the screening population was calculated,and Chi-square test was used to compare the differences of detection rate and early diagnosis rate between the primary screening population and the follow-up population.Results The age of 116630 primary screening population was(54.29±7.70)years old,and the proportion of males was 41.2%(48108).In the primary screening population,patients with normal esophagus,mild to moderate dysplasia,severe dysplasia and above accounted for 92.91%(108363),6.03%(7035)and 1.06%(1232),respectively.The detection rate of esophageal cancer was 1.06%(1232/116630),and the rate of early diagnosis was 85.80%(1057).Among the follow-up population of 6154 people,those with normal esophagus,mild to moderate dysplasia,severe dysplasia and above diseases accounted for 63.45%(3905),33.13%(1519)and 3.41%(210),respectively.The detection rate of esophageal cancer was 3.41%(210/6154),and the rate of early diagnosis was 91.90%(1939).Compared with the primary screening population,the risk of esophageal cancer was higher in the overall follow-up population,people either with mild or with moderate dysplasia diagnosed in primary screening,with OR values(95%CI)of 3.23(2.78,3.75),1.85(1.49,2.29)and 8.13(6.69,9.88),respectively.Conclusion From 2014 to 2018,in the early diagnosis and early treatment of upper digestive tract cancer project in rural areas of Henan Province,the detection rate of the follow-up population is significantly higher than that of the primary screening population.Improving follow-up rate and paying more attention to the screening of people who need follow-up could further improve the screening effect.