Endoscopy screening effect on stage distributions of esophageal cancer: A cluster randomized cohort study in China.
Endoscopy screening effect on stage distributions of esophageal cancer: A cluster randomized cohort study in China.
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DOI：
10.1111/cas.13606
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发表时间：
2018-06
期刊：
影响因子：
5.7
通讯作者：
Wei WQ
中科院分区：
文献类型：
--
作者：
Guan CT;Song GH;Li BY;Gong YW;Hao CQ;Xue LY;Chen WQ;Wei WQ
食道癌的内窥镜筛查的有效性还不够明确，缺乏随机对照试验证据。本研究通过描述和比较干预人群和对照人群的疾病阶段分布，证明了短期筛查的有效性。将林州和磁县的村庄随机分为干预组和对照组，目标人群分别为40岁~69岁的52人、729人和43,068人，实际登记人数分别为18人、316人和21人178人。收集2012-2016年间食管瘤的TNM分期信息和研究定义的分期信息。比较了干预组和对照组在总目标人群中的阶段分布，以及在登记人数和干预前后的亚组人群中的阶段分布。干预组和对照组食道癌病例总数分别为199例和141例。在目标人群中，干预后两组患者的TNM分期差异有统计学意义(P<0.05)。然而，对干预后登记人群的亚组分析在TNM和研究定义的阶段都具有统计学意义。在干预人群中，I-IV期的自然TNM分期分布约为32%、41%、24%和3%，而干预人群为71%、19%、7%和3%。研究定义的早期、中期和晚期的自然分期分布分别约为18%、49%和33%，而59%、33%和8%。早期食道癌患者经内窥镜筛查后所占比例较高，其在目标人群中的疗效取决于干预依从性。
Efficacy of endoscopic screening for esophageal cancer is not sufficiently definitive and lacks randomized controlled trial evidence. The present study proved short‐term screening efficacy through describing and comparing disease stage distributions of intervention and control populations. Villages from Linzhou and Cixian were cluster randomly allocated to the intervention or to the control group and the target population of 52 729 and 43 068 individuals was 40‐69 years old, respectively, and the actual enrolled numbers were 18 316 and 21 178, respectively. TNM stage information and study‐defined stage information of esophageal cases from 2012 to 2016 were collected. Stage distributions were compared between the intervention and control groups in the total target population, as well as in the subgroup populations in terms of enrolment and before or after intervention. There were a total of 199 and 141 esophageal cancer cases in the intervention and control groups, respectively. For the target population, distributions of TNM stage were borderline significant between the two groups after intervention (P = .093). However, subgroup analysis of the enrolled population during the after‐intervention period had statistical significance for both TNM and study‐defined stage. Natural TNM stage distributions were approximately 32%, 41%, 24% and 3% for stages I to IV vs 71%, 19%, 7% and 3% in the intervention population. The natural study‐defined stage distributions from early, middle to advanced stages were approximately 18%, 49% and 33% vs 59%, 33% and 8%. Early‐stage esophageal cancer cases accounted for a higher proportion after endoscopy screening, and the efficacy in the target population depends on the intervention compliance.
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