Long-Term Follow-Up of a Community Assignment, One-Time Endoscopic Screening Study of Esophageal Cancer in China
Long-Term Follow-Up of a Community Assignment, One-Time Endoscopic Screening Study of Esophageal Cancer in China
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DOI：
10.1200/jco.2014.58.0423
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发表时间：
2015-06-10
影响因子：
45.3
通讯作者：
Qiao, You-Lin
中科院分区：
文献类型：
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作者：
Wei, Wen-Qiang;Chen, Zhi-Feng;Qiao, You-Lin
目的目前尚无针对食管鳞癌的全球筛查建议。自20世纪70年代以来，中国在高发区开展了内窥镜筛查工作。本研究旨在评估内窥镜筛查和干预计划是否可以降低食管鳞癌的死亡率。14个村被选为干预社区。选择了10个地理上与干预村不相邻的村庄进行比较。干预组采用Lugol‘s碘染色对患者进行一次胃镜筛查，对有不典型增生或隐匿性癌患者进行治疗。所有干预参与者和由十分之一的对照组组成的样本完成了问卷调查。结果干预组从6827名符合条件的人群中筛选出3319名志愿者(48.62%)。来自控制组6,200名合格人口的797名志愿者接受了采访。在10年的随访中，发现了652起事件和542起致死的食管状细胞癌。与对照组相比，干预组的累积死亡率明显降低(分别为3.35%和5.05%；P<；.001)。此外，干预组食管鳞癌的累积发病率显著低于对照组(分别为4.17%和5.92%；P<；.001)。结论我们发现内窥镜筛查和干预显著降低了食道癌的死亡率。癌前病变的检测和治疗也降低了这种高度致命的癌症的发病率。(C)2015年度美国临床肿瘤学会
PurposeThere are no global screening recommendations for esophageal squamous cell carcinoma (ESCC). Endoscopic screening has been investigated in areas of high incidence in China since the 1970s. This study aimed to evaluate whether an endoscopic screening and intervention program could reduce mortality caused by ESCC.MethodsResidents age 40 to 69 years were recruited from communities with high rates of ESCC. Fourteen villages were selected as the intervention communities. Ten villages not geographically adjacent to intervention villages were selected for comparison. Participants in the intervention group were screened once by endoscopy with Lugol's iodine staining, and those with dysplasia or occult cancer were treated. All intervention participants and a sample consisting of one tenth of the control group completed questionnaires. We compared cumulative ESCC incidence and mortality between the two groups.ResultsThree thousand three hundred nineteen volunteers (48.62%) from an eligible population of 6,827 were screened in the intervention group. Seven hundred ninety-seven volunteers from an eligible population of 6,200 in the control group were interviewed. Six hundred fifty-two incident and 542 fatal ESCCs were identified during the 10-year follow-up. A reduction in cumulative mortality in the intervention group versus the control group was apparent (3.35% v 5.05%, respectively; P < .001). Furthermore, the intervention group had a significantly lower cumulative incidence of ESCC versus the control group (4.17% v 5.92%, respectively; P < .001).ConclusionWe showed that endoscopic screening and intervention significantly reduced mortality caused by esophageal cancer. Detection and treatment of preneoplastic lesions also led to a reduction in the incidence of this highly fatal cancer. (C) 2015 by American Society of Clinical Oncology