2012～2016年四川省阆中市食管癌内镜筛查结果分析
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摘要
目的:分析食管癌高发区40~69岁农村居民食管癌内镜筛查结果,探讨食管癌及各级癌前病变的患病及早诊早治情况。方法:2012-2016年在食管癌高发区四川省阆中市采取整群随机抽样的方法,选择行政自然村为基本单元,以全部40-69岁当地农村居民作为筛查对象,对其进行上消化道内镜检查并进行碘染色及指示性活检,以组织病理学诊断作为最终确诊。结果:2012~2016年阆中市的18个乡镇共筛查40~69岁农村居民10102例,各级食管病变检出率为22.73%(2296/10102),食管阳性病例检出率为1.77%(179/10102),食管癌前病变检出率为5.49%(555/10102)。男性食管各级病变总体检出率以及食管癌前病变、阳性病例的检出率分别高于女性(9.36%vs.5.44%,7.03%vs.4.06%,2.34%vs.1.37%);男性食管轻度异型增生、中度异型增生、重度异型增生/原位癌以及食管浸润癌的检出率均分别高于女性(5.81%vs.3.42%,1.22%vs.0.64%,1.83%vs.1.17%,0.38%vs.0.14%),差异有统计学意义(均P<0.05)。食管各级病变总体检出率、食管癌前病变、阳性病例的检出率以及食管轻度异型增生、中度异型增生、重度异型增生/原位癌的检出率均随着年龄的增长呈逐渐升高的趋势,60岁以后增长明显,差异均有统计学意义(均P<0.05)。结论:阆中市食管癌高发区农村居民食管癌内镜筛查及早诊早治工作已初步显示出良好的效果,应重视癌前病变患者的早期诊断、治疗与随访。
Objective: To analyze the endoscopic screening results for esophageal cancer in rural population aged40-69 years in high incidence areas,and to investigate the prevalence,early diagnosis and treatment of esophageal carcinoma and precancerous lesions at all levels. Methods: Cluster random sampling method was adopted to select residents aged 40-69 years from several natural villages as screening objects for upper gastrointestinal endoscopy,iodine staining and biopsy,regarding histopathological diagnosis as final diagnosis in Langzhong,Sichuan Province,from 2012 to 2016.Results: In 2012 ~ 2016,10102 rural residents aged 40 ~ 69 from 18 villages and towns in Langzhong city were screened The detection rate of esophageal lesions at all levels was 22.73%( 2296/10102); the detection rate of positive cases of esophagus was 1. 77%( 179/10102),while the detection rate of precancerous lesions of esophageal carcinoma was 5.49%( 555/10102). All levels of total examination rate of male esophagus and the detection rate of esophageal precancerous lesions,the rate of positive cases were higher than that of female( 9. 36% vs. 5. 44%,7. 03% vs. 4. 06%,2. 34% vs. 1. 37%); The detection rates of mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ and invasive carcinoma of the esophagus were higher in males than that in females( 5. 81% vs. 3. 42%,1. 22% vs. 0. 64%,1. 83% vs. 1. 17%,0. 38% vs. 0. 14%),and the difference was statistically significant( P < 0. 05). The total detection rate of esophageal lesions at all levels,the positive cases of esophageal precancerous lesions,the detection rate of esophageal and mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ detection rate showed an increasing trend with age,and after the age of 60,the increase was obvious,which the differences were statistically significant( P < 0. 05). Conclusion: The work of endoscopic screening,early diagnosis and early treatment of esophageal cancer in rural residents with high incidence of esophageal cancer in Langzhong City has shown good results,and attention should be paid to the early diagnosis,treatment and follow-up of patients with precancerous lesions.
Objective: To analyze the endoscopic screening results for esophageal cancer in rural population aged40-69 years in high incidence areas,and to investigate the prevalence,early diagnosis and treatment of esophageal carcinoma and precancerous lesions at all levels. Methods: Cluster random sampling method was adopted to select residents aged 40-69 years from several natural villages as screening objects for upper gastrointestinal endoscopy,iodine staining and biopsy,regarding histopathological diagnosis as final diagnosis in Langzhong,Sichuan Province,from 2012 to 2016.Results: In 2012 ~ 2016,10102 rural residents aged 40 ~ 69 from 18 villages and towns in Langzhong city were screened The detection rate of esophageal lesions at all levels was 22.73%( 2296/10102); the detection rate of positive cases of esophagus was 1. 77%( 179/10102),while the detection rate of precancerous lesions of esophageal carcinoma was 5.49%( 555/10102). All levels of total examination rate of male esophagus and the detection rate of esophageal precancerous lesions,the rate of positive cases were higher than that of female( 9. 36% vs. 5. 44%,7. 03% vs. 4. 06%,2. 34% vs. 1. 37%); The detection rates of mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ and invasive carcinoma of the esophagus were higher in males than that in females( 5. 81% vs. 3. 42%,1. 22% vs. 0. 64%,1. 83% vs. 1. 17%,0. 38% vs. 0. 14%),and the difference was statistically significant( P < 0. 05). The total detection rate of esophageal lesions at all levels,the positive cases of esophageal precancerous lesions,the detection rate of esophageal and mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ detection rate showed an increasing trend with age,and after the age of 60,the increase was obvious,which the differences were statistically significant( P < 0. 05). Conclusion: The work of endoscopic screening,early diagnosis and early treatment of esophageal cancer in rural residents with high incidence of esophageal cancer in Langzhong City has shown good results,and attention should be paid to the early diagnosis,treatment and follow-up of patients with precancerous lesions.
引文
[1]陈万青,左婷婷.中国上消化道癌防控初显成效[J].中华预防医学杂志,2017,51(5)∶378-380.
[2]Ferlay J,Soerjomataram I,Ervik M,et al.GLOBOCAN 2012 v1.0Cancer Incidence and Mortality Worldwide∶IARC Cancer Base No.11[M].Lyon∶International Agency for Research on Cancer,2013.
[3]贺宇彤,李道娟,梁迪,等.2013年中国食管癌发病和死亡估计[J].中华肿瘤杂志,2017,39(4)∶315-320.
[4]杨千三,刘乔虹,吴鹏,等.2015年四川省阆中市居民主要死因特征分析[J].职业卫生与病伤,2017,32(1)∶38-42.
[5]王霄,王安荣,樊晋川,等.食管癌高发区居民食管癌及癌前病变状况分析[J].东南大学学报∶医学版,2013,32(1)∶56-59.
[6]卫生部疾病预防控制局,癌症早诊早治项目专家委员会.癌症早诊早治项目技术方案(2011年版)[M].北京∶人民卫生出版社,2011∶6-9.
[7]Wang X,Fan JC,Wang AR,et al.Epidemiology of esophageal cancer in Yanting regional report of a national screening programme in China[J].Asian Pac J Cancer Prev,2013,14(4)∶2429-2432.
[8]王孟,郝长青,赵德利,等.2005-2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究[J].中华预防医学杂志,2015,49(8)∶677-682.
[9]Chen Q,Yu L,Hao C,et al.Effectiveness evaluation of organized screening for esophageal cancer∶a case-control study in Linzhou city,China[J].Sci Rep,2016,19(6)∶35707
[10]Chen Q,Yu L,Hao CQ,et al.Effectiveness of endoscopic gastric cancer screening in a rural area of Linzhou,China∶results from a case-control study[J].Cancer Med,2016,5(9)∶2615-2622.
[11]王霄,李博,包郁,等.四川省105561例高危人群食管癌筛查结果分析[J].中华肿瘤杂志,2017,39(1)∶67-71.
[12]张萌,李鑫,张韶凯,等.河南省12个市、县食管癌筛查效果分析[J].中华预防医学杂志,2015,49(10)∶879-882.
[13]董志伟,乔友林,王贵齐,等.癌症早诊早治的评价[J].中华肿瘤杂志,2012,34(8)∶637-640.
[14]梁圣勇,李凯,龚继勇,等.2006-2012年山东省肥城市食管癌和贲门癌内镜筛查结果分析究[J].中华肿瘤杂志,2015,37(7)∶549-553.
[15]敬元华,姚益猛,帅丕洪,等.四川省南部县14000例40~69岁高危人群食管癌筛查结果分析[J].肿瘤预防与治疗,2017,30(1)∶49-52.
[16]宋国慧,孟凡书,白文龙,等.磁县食管癌高发区高危人群食管癌前状态及病变分析[J].中国肿瘤临床,2014,41(19)∶1259-1263.
[17]刘志才,连士勇,李变云,等.林州食管癌高发区内镜筛查食管、贲门病变分析[J].中国肿瘤,2014,23(2)∶124-127.
[18]郭秀明,陈姗姗,杨军,等.高台县40~69岁居民2011-2013年食管癌、贲门癌及胃癌发病筛查分析[J].中国初级卫生保健,2015,29(1)∶121-122.
[2]Ferlay J,Soerjomataram I,Ervik M,et al.GLOBOCAN 2012 v1.0Cancer Incidence and Mortality Worldwide∶IARC Cancer Base No.11[M].Lyon∶International Agency for Research on Cancer,2013.
[3]贺宇彤,李道娟,梁迪,等.2013年中国食管癌发病和死亡估计[J].中华肿瘤杂志,2017,39(4)∶315-320.
[4]杨千三,刘乔虹,吴鹏,等.2015年四川省阆中市居民主要死因特征分析[J].职业卫生与病伤,2017,32(1)∶38-42.
[5]王霄,王安荣,樊晋川,等.食管癌高发区居民食管癌及癌前病变状况分析[J].东南大学学报∶医学版,2013,32(1)∶56-59.
[6]卫生部疾病预防控制局,癌症早诊早治项目专家委员会.癌症早诊早治项目技术方案(2011年版)[M].北京∶人民卫生出版社,2011∶6-9.
[7]Wang X,Fan JC,Wang AR,et al.Epidemiology of esophageal cancer in Yanting regional report of a national screening programme in China[J].Asian Pac J Cancer Prev,2013,14(4)∶2429-2432.
[8]王孟,郝长青,赵德利,等.2005-2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究[J].中华预防医学杂志,2015,49(8)∶677-682.
[9]Chen Q,Yu L,Hao C,et al.Effectiveness evaluation of organized screening for esophageal cancer∶a case-control study in Linzhou city,China[J].Sci Rep,2016,19(6)∶35707
[10]Chen Q,Yu L,Hao CQ,et al.Effectiveness of endoscopic gastric cancer screening in a rural area of Linzhou,China∶results from a case-control study[J].Cancer Med,2016,5(9)∶2615-2622.
[11]王霄,李博,包郁,等.四川省105561例高危人群食管癌筛查结果分析[J].中华肿瘤杂志,2017,39(1)∶67-71.
[12]张萌,李鑫,张韶凯,等.河南省12个市、县食管癌筛查效果分析[J].中华预防医学杂志,2015,49(10)∶879-882.
[13]董志伟,乔友林,王贵齐,等.癌症早诊早治的评价[J].中华肿瘤杂志,2012,34(8)∶637-640.
[14]梁圣勇,李凯,龚继勇,等.2006-2012年山东省肥城市食管癌和贲门癌内镜筛查结果分析究[J].中华肿瘤杂志,2015,37(7)∶549-553.
[15]敬元华,姚益猛,帅丕洪,等.四川省南部县14000例40~69岁高危人群食管癌筛查结果分析[J].肿瘤预防与治疗,2017,30(1)∶49-52.
[16]宋国慧,孟凡书,白文龙,等.磁县食管癌高发区高危人群食管癌前状态及病变分析[J].中国肿瘤临床,2014,41(19)∶1259-1263.
[17]刘志才,连士勇,李变云,等.林州食管癌高发区内镜筛查食管、贲门病变分析[J].中国肿瘤,2014,23(2)∶124-127.
[18]郭秀明,陈姗姗,杨军,等.高台县40~69岁居民2011-2013年食管癌、贲门癌及胃癌发病筛查分析[J].中国初级卫生保健,2015,29(1)∶121-122.