Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study
Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study
复制标题
中国食管癌强化内镜筛查的有效性：基于社区的研究
DOI：
10.1093/aje/kwy291
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发表时间：
2019-04-01
影响因子：
5
通讯作者：
Ke, Yang
中科院分区：
文献类型：
--
作者：
Liu, Mengfei;He, Zhonghu;Ke, Yang
评估食管癌（EC）人群内镜筛查的有效性需要证据。本研究将来自中国河南省华县6个村的5632名年龄在25-65岁的常住居民定义为筛查队列，并对其进行强化内镜筛查。选取华县剩余914个村的居民作为对照队列，采用年龄-性别标准化计算筛查队列中EC和上消化道肿瘤的预期病例数和死亡人数。通过将观察到的病例数和死亡人数与筛查对象（2007-2016年）随访9年后的预期人数进行比较，评估筛查的有效性。在筛查队列中，确定了23例上消化道癌症（包括16例EC）和10例上消化道癌症死亡（包括5例EC死亡），发现累积EC发病率和死亡率降低了47%（标准化发病率比= 0.53,95%置信区间（CI）： 0.33, 0.87）和66%（标准化死亡率比= 0.34,95% CI: 0.14, 0.81）。对于上消化道癌症，发病率和死亡率分别降低43%（标准化发病率比= 0.57,95% CI: 0.38, 0.86）和53%（标准化死亡率= 0.47,95% CI: 0.25, 0.88）。本研究表明，上消化道内窥镜检查在高危地区是一种有效的人群筛查方法。
Evidence is required to evaluate the effectiveness of population-level endoscopic screening for esophageal cancer (EC). In this study, 5,632 permanent residents aged 25-65 years from 6 villages in Hua County, Henan Province, China, were defined as the screening cohort and were offered intensive endoscopic screening. Residents of all 914 remaining villages in Hua County were included as the control cohort, and age-sex standardization was used to calculate the expected numbers of EC and upper gastrointestinal (GI) tract cancer cases and deaths in the screening cohort. The effectiveness of screening was assessed by comparing observed numbers of cases and deaths with expected numbers after 9-year follow-up of these screened subjects (2007-2016). In the screening cohort, 23 upper GI cancers (including 16 ECs) and 10 upper GI cancer deaths (including 5 EC deaths) were identified, and 47% (standardized incidence ratio = 0.53, 95% confidence interval (CI): 0.33, 0.87) and 66% (standardized mortality ratio = 0.34, 95% CI: 0.14, 0.81) reductions in cumulative EC incidence and mortality were found. For upper GI cancers, incidence and mortality were lowered by 43% (standardized incidence ratio = 0.57, 95% CI: 0.38, 0.86) and 53% (standardized mortality ratio = 0.47, 95% CI: 0.25, 0.88), respectively. This study showed that upper GI tract endoscopy is an effective population-level screening test for EC in high-risk regions.