山东省肥城市2006-2012年676例食管癌前病变内镜筛查结果分析

目的]研究食管癌高发地区食管癌前病变转归情况及其影响因素,为食管癌前病变及食管鳞癌的防治工作提供科学依据。方法]采用历史性队列研究方法对山东省肥城市2006-2012年期间接受筛查未治疗,并进行病理检查随访的受检者资料进行分析,描述首检及随访筛检结果,分析影响癌前病变发生、发展的因素。结果]676例首检者接受随访,筛检结果为417例(61.7%)发生逆转,157例(23.2%)保持稳定,102例(15.1%)发生进展。102例进展者的病理诊断结果分别为9例食管炎,26例轻度异型增生,27例中度异型增生,30例重度异型增生原位癌,10例食管癌。其中基底细胞增生平均间隔为2.7年,随访结果为食管癌,轻度异常增生为6.3年,中度异常增生为2.9年,重度异型增生/原位癌为1.0年。男性、饮酒、饮茶为癌前病变发生、发展的危险因素,其OR值和95%CI值分别为1.712(1.088~2.694)、1.611(1.058~2.453)、1.784(1.004~3.170);年龄<55岁为癌前病变发生、发展的保护因素。结论]首检后对基底细胞增生和轻度异型增生应间隔2年复查一次,对中度异型增生和未治疗的重度异型增生/原位癌应间隔半年复查一次,以减少早期癌的漏诊率;对男性、年龄≥55岁、饮酒、饮茶的癌前病变人群应加强筛查力度。

Analysis of Endoscopic Screening Results of 676 Cases of Esophageal Precancerous Lesion from 2006 to 2012 in Feicheng County,Shandong Province

Purpose] To study the prognosis of esophageal precancerous lesions and its influencing factors in high-incidence areas of esophageal squamous cell carcinomas and to provide scientific basis for prevention and control of esophageal squamous cell carcinomas. Methods] The retrospective cohort study was used to analyze the data of subjects who accepted screening but remained untreated and had follow-up screening from 2006 to 2012 in Feicheng county,Shandong province,and the first and follow-up screening results were collected to analyze the relevant influencing factors of the progression of precancerous lesions. Results] The results of follow-up screening tests in 676 cases were 417 cases(61.7%) reversed,157 cases(23.2%) remained stable,and 102 cases(15.1%) progressed. The specific pathological diagnosis results of 102 patients with progression were 9 cases of esophagitis,26 cases of mild dysplasia,27 cases of moderate dysplasia,30 cases of severe dysplasia carcinoma in situ,and 10 cases of esophageal cancer. The average time interval from basal cell hyperplasia to esophageal cancer was 2.7 years,mild dysplasia to esophageal cancer was 6.3 years,moderate dysplasia to esophageal cancer was 2.9 years,and severe dysplasia/carcinoma in situ to esophageal cancer was 1.0 year. Male,alcohol and tea consumption were risk factors for the development of precancerous lesions,and OR and 95%CI values were 1.712(1.088~2.694),1.611(1.058~2.453) and 1.784(1.004~3.170),respectively. Age <55 years old was a protective factor for the development of precancerous lesions. Conclusion] Patients whose histological results were basal cell hyperplasia and mild dysplasia should be retested every other two years after the first test,and patients with moderate abnormal hyperplasia and untreated severe dysplasia/carcinoma in situ should be retested every six months,to reduce misdiagnosis rate in the early stage. Screening should be strengthened for those who were male,aged≥55 years old,alcohol drinkers and tea drinkers.