Update version of the Japanese Guidelines for Gastric Cancer Screening
Update version of the Japanese Guidelines for Gastric Cancer Screening
复制标题
DOI：
10.1093/jjco/hyy077
复制
发表时间：
2018-07-01
影响因子：
2.4
通讯作者：
Hamashima, Chisato
中科院分区：
文献类型：
--
作者：
Hamashima, Chisato
背景：虽然胃癌的发病率和死亡率已逐渐下降，但其负担仍然存在于东亚国家。胃癌筛查自1983年在日本开始实施，新的筛查技术的引进备受期待。目的：为了促进循证筛查，根据新的研究结果对日本胃癌筛查指南进行了修订。方法：根据以前建立的方法制定了胃癌筛查指南。为了评估有关筛查方法有效性的证据，基于包括旨在降低胃癌死亡率的临床问题的分析框架进行了系统评价。评估了以下胃癌筛查方法：上消化道系列（放射学筛查）、胃肠道内镜检查（内镜筛查）、幽门螺杆菌抗体检测和血清胃蛋白酶原检测。基于每个筛查方法的利益和危害的平衡，建议以人群为基础的和机会性screenings.Findings：后日本胃癌筛查指南发表于2005年，几个观察性研究的放射学和内窥镜筛查已被报道。三项病例对照研究评价了内镜筛查降低胃癌死亡率的作用。值得注意的是，H.幽门螺杆菌抗体和血清胃蛋白酶原试验不足。虽然在内镜和放射学筛查中观察到假阳性结果、假阴性结果和并发症，但内镜筛查的并发症发生率高于放射学筛查。过度诊断并没有直接估计在这两种methods.Recommendations：放射学和内镜筛查胃癌的建议，以人口为基础的机会性筛查。螺杆幽门抗体和血清胃蛋白酶原试验不推荐用于基于人群的筛查，因为证据不足。
Background: Although the incidence and mortality of gastric cancer have gradually decreased, its burden remains in East Asian countries. Gastric cancer screening has been performed in Japan since 1983, and the introduction of new screening techniques has been eagerly anticipated.Objective: To promote evidence-based screening, the Japanese guidelines for gastric cancer screening have been revised based on the new studies.Methods: The guidelines for gastric cancer screening have been developed according to a previously established method. To assess evidence regarding the effectiveness of the screening methods, a systematic review was conducted based on an analytic framework including clinical questions aiming at reducing mortality from gastric cancer. The following methods were assessed for gastric cancer screening: upper gastrointestinal series (radiographic screening), gastrointestinal endoscopy (endoscopic screening), Helicobacter pylori antibody test and serum pepsinogen tests. Based on the balance of the benefits and harms of each screening method, recommendations for population-based and opportunistic screenings were formulated.Findings: After the Japanese guidelines for gastric cancer screening were published in 2005, several observational studies on radiographic and endoscopic screenings have been reported. Three case-control studies have evaluated mortality reduction from gastric cancer by endoscopic screening. Notably, evidence of the H. pylori antibody and serum pepsinogen tests was insufficient. Although false-positive results, false-negative results, and complications were observed in endoscopic and radiographic screenings, the complication rates were higher in endoscopic screening than in radiographic screening. Overdiagnosis was not estimated directly in both methods.Recommendations: Radiographic and endoscopic screenings for gastric cancer are recommended for population-based and opportunistic screenings. The H. pylori antibody and serum pepsinogen tests are not recommended for population-based screening because of insufficient evidence.