2013-2018年浙江省城市癌症早诊早治项目人群肝癌筛查结果及相关因素分析

目的分析2013-2018年浙江省城市癌症早诊早治项目人群肝癌筛查结果及相关因素。方法于2013年9月至2019年8月,以浙江省杭州(江干区和拱墅区)、宁波(海曙区、鄞州区和江北区)和衢州市(柯城区)的6个城市社区为研究现场,采用整群抽样方法,选取所有年龄为40~74岁的常住居民(具有本地户籍且在本地居住3年以上)为研究对象,排除已确诊肿瘤患者、罹患其他严重内外科疾病正在治疗的患者后,共纳入166293名研究对象。通过问卷调查收集研究对象的基本人口学特征和危险因素等信息,采用癌症风险评估系统评价研究对象的肝癌患病风险,同时从项目参与医院获取肝癌高危人群的临床筛查参与情况和筛查结果,计算肝癌高危率、临床筛查率、阳性病变检出率及疑似肝癌检出率等结果,并采用Poisson回归模型分析肝癌检出的相关因素。结果166293名研究对象年龄为(56.01±8.40)岁,其中男性占41.36%(68777名)。共筛出23765名肝癌高危人群(高危率为14.29%);其中,共有12375名对象参加了肝癌临床筛查,筛查率为52.07%(12375/23765);共检出297例阳性病变,检出率为2.40%(297/12375);其中检出8例疑似肝癌,检出率为0.06%(8/12375)。多因素Poisson回归模型分析结果显示,与男性、从不吸烟、从不食用腌晒食品、食用油脂含量不高、无肝胆系统疾病史的人群相比,女性、正在吸烟/曾经吸烟、有时食用腌晒食品、食用油脂含量较高、有肝胆系统疾病史人群的阳性病变检出率更高,发生率比(IRR)(95%CI)值分别为1.98(1.45~2.70)、2.23(1.61~3.09)/2.08(1.31~3.28)、1.82(1.22~2.70)、1.44(1.08~1.91)、1.45(1.05~2.00);与40~49岁、未做过HBsAg检测相比,70~74岁、HBsAg阳性人群的疑似肝癌检出率更高,IRR(95%CI)值分别为16.30(1.32~200.74)、6.43(1.24~33.22)。结论浙江省城市癌症早诊早治项目肝癌临床筛查依从性较好,在肝癌高危人群中进行腹部超声检查和血清甲胎蛋白检测有助于发现肝癌及其癌前病变。

Analysis of liver cancer screening results and influencing factors of urban residents in Zhejiang Province from 2013 to 2018

Objective To analyze the results of liver cancer screening for urban residents in Zhejiang Province from 2013 to 2018 and explore the influencing factors of the detection rate.Methods From September 2013 to August 2019,six urban communities in Hangzhou(Jianggan District and Gongshu District),Ningbo(Haishu District,Yinzhou District and Jiangbei District),and Quzhou(Kecheng District)were selected as study sites.All permanent residents aged 40-74(with local household registration and living in the local area for more than 3 years)were selected as the research subjects by using cluster sampling method.Patients with confirmed cancers and other serious medical and surgical diseases were excluded.A total of 166293 research subjects were included.Basic demographic characteristics and risk factors of subjects were obtained through questionnaire surveys.The cancer risk assessment system was used to evaluate the liver cancer risk of subjects.Clinical screening participation and screening results for subjects at high risk of liver cancer were obtained from participating hospitals.The high-risk rate of liver cancer,clinical screening rate,detection rate of positive lesions,and detection rate of suspected liver cancer were analyzed.Poisson regression was used to analyze the influencing factors of detection rate.Results The age of 166293 subjects was(56.01±8.40)years,of which 41.36%(68777)were males.A total of 23765 high-risk subjects for liver cancer were screened(the high-risk rate was 14.29%).Among them,a total of 12375 subjects participated in clinical screening for liver cancer,with a screening rate of 52.07%(12375/23765).A total of 297 cases of positive lesions were detected and the detection rate was 2.40%(297/12375).A total of 8 cases of suspected liver cancer were detected,with a detection rate of 0.06%(8/12375).The results of multivariate Poisson regression model analysis showed that compared with men,people who never smoked,never ate pickled food,had low oil content,and had no history of hepatobiliary disease,female,people who were smoking or had smoked,sometimes ate pickled food,ate higher oil content,and had a history of hepatobiliary disease had a higher detection rate of positive lesions.The incidence rate ratio(IRR)(95%CI)values were 1.98(1.45-2.70),2.23(1.61-3.09)/2.08(1.31-3.28),1.82(1.22-2.70),1.44(1.08-1.91),and 1.45(1.05-2.00),respectively.Compared with those aged from 40 to 49 years old and without HBsAg test,the IRR(95%CI)of suspected liver cancer in people aged 70 to 74 years old and HBsAg positive were 16.30(1.32-200.74)and 6.43(1.24-33.22),respectively.Conclusion The urban cancer early diagnosis and early treatment project in Zhejiang Province has good compliance in clinical screening of liver cancer.Abdominal ultrasound examination and serum alpha-fetoprotein detection are helpful to detect liver cancer and its precancerous lesions in the high-risk population of liver cancer.