Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality
Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality
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DOI：
10.1053/j.gastro.2017.01.029
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发表时间：
2017-05-01
期刊：
影响因子：
29.4
通讯作者：
Lee, Dukhyoung
中科院分区：
文献类型：
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作者：
Jun, Jae Kwan;Choi, Kui Son;Lee, Dukhyoung
背景与目的：通过上消化道内镜检查或上消化道（UGI）系列检查（通过影像学技术观察胃肠道的上部和中部）筛查胃癌是否能降低死亡率尚不清楚。然而，韩国国家胃癌筛查计划于1999年启动，使用这些技术对40岁及以上人群进行胃癌筛查。我们评估了这些技术在胃癌检测中的有效性，并比较了它们对韩国人群死亡率的影响。
方法：我们利用2002年以来韩国国家胃癌筛查计划的数据进行了一项巢式病例对照研究。共有16584283名40岁及以上的韩国男性和女性组成无癌队列。病例组（n = 54418）定义为2004年1月至2009年12月新诊断为胃癌且在2012年12月前死亡的个体。病例与对照组（在相应病例死亡日期时仍存活的个体，n = 217672）按照进入研究队列的年份、年龄、性别和社会经济状况进行匹配。通过条件逻辑回归分析获得比值比（OR）和95%置信区间（CI）。
结果：与从未接受筛查的受试者相比，接受过筛查的受试者死于胃癌的总体比值比为0.79（95%CI，0.77 - 0.81）。根据筛查方式，上消化道内镜检查死于胃癌的比值比为0.53（95%CI，0.51 - 0.56），UGI系列检查为0.98（95%CI，0.95 - 1.01）。随着每个受试者接受内镜筛查次数的增加，死于胃癌的比值比降低：分别为一次0.60（95%CI，0.57 - 0.63）、两次0.32（95%CI，0.28 - 0.37）以及三次或更多次0.19（95%CI，0.14 - 0.26）。
结论：在韩国国家癌症筛查计划中，接受上消化道内镜检查的患者死于胃癌的可能性较低；UGI系列检查未发现相关关联。
BACKGROUND & AIMS: It is not clear whether screening for gastric cancer by upper endoscopy or upper gastrointestinal (UGI) series examinations (looking at the upper and middle sections of the gastrointestinal tract by imaging techniques) reduces mortality. Nevertheless, the Korean National Cancer Screening Program for gastric cancer was launched in 1999 to screen individuals 40 years and older for gastric cancer using these techniques. We evaluated the effectiveness of these techniques in gastric cancer detection and compared their effects on mortality in the Korean population. METHODS: We performed a nested case-control study using data from the Korean National Cancer Screening Program for gastric cancer since 2002. A total of 16,584,283 Korean men and women, aged 40 years and older, comprised the cancer-free cohort. Case subjects (n = 54,418) were defined as individuals newly diagnosed with gastric cancer from January 2004 through December 2009 and who died before December 2012. Cases were matched with controls (subjects who were alive on the date of death of the corresponding case subject, n = 217,672) for year of entry into the study cohort, age, sex, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained via conditional logistic regression analysis. RESULTS: Compared with subjects who had never been screened, the overall OR for dying from gastric cancer among ever-screened subjects was 0.79 (95% CI, 0.77-0.81). According to screening modality, the ORs of death from gastric cancer were 0.53 (95% CI, 0.51-0.56) for upper endoscopy and 0.98 (95% CI, 0.95-1.01) for UGI series. As the number of endoscopic screening tests performed per subject increased, the ORs of death from gastric cancer decreased: 0.60 (95% CI, 0.57-0.63), 0.32 (95% CI, 0.28-0.37), and 0.19 (95% CI, 0.14-0.26) for once, twice, and 3 or more times, respectively. CONCLUSIONS: Within the Korean National Cancer Screening Program, patients who received an upper endoscopy were less likely to die from gastric cancer; no associations were found for UGI series.