Mizoue Tetsuya, Yoshimura Takesumi, Tokui Noritaka, Hoshiyama Yoshiharu, Yatsuya Hiroshi, Sakata Kiyomi, Kondo Takaaki, Kikuchi Shogo, Toyoshima Hideaki, Hayakawa Norihiko, Tamakoshi Akiko, Ohno Yoshiyuki, Fujino Yoshihisa, Kaneko Satoshi
Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Japan.
Int J Cancer. 2003 Aug 10;106(1):103-7. doi: 10.1002/ijc.11183.
Although screening for stomach cancer is a widespread community service in Japan, the benefits of the screening program remain unclear. Our study investigated prospectively the relation between participation in stomach-cancer screening during the past 12 months and subsequent deaths. Data was derived from the Japan Collaborative Cohort Study, in which 480 stomach-cancer deaths were identified during an 8-year follow-up period. Cox proportional hazard regression was used to estimate the relative risk of death from stomach cancer and that from other causes while adjusting for potential confounding factors. In men, screening participation was associated significantly with a reduced risk of death from stomach cancer (relative risk [RR] = 0.54; 95% confidence interval [CI] = 0.41-0.70). The extent of the risk reduction was greater than potential health selection (for deaths other than stomach, RR = 0.71). The adjustment for potential confounding variables, however, attenuated the difference in risk of death (stomach cancer, RR = 0.65; other causes, RR = 0.71). In women, the magnitude of the association between screening participation and death from stomach cancer (RR = 0.74; 95% CI = 0.52-1.07) was equal to that for deaths from non-stomach cancers (RR = 0.74). Subgroup analysis showed that women with a parental history of stomach cancer had a reduced risk of death from stomach cancer associated with screening (RR = 0.32; 95% CI = 0.12-0.87). The present results underline the potential for selection bias in observational studies, and thus it remains an open question whether screening for stomach cancer is effective.
尽管在日本，胃癌筛查是一项广泛开展的社区服务，但该筛查项目的益处仍不明确。我们的研究前瞻性地调查了过去12个月内参与胃癌筛查与后续死亡之间的关系。数据来源于日本协作队列研究，在8年的随访期内共确定了480例胃癌死亡病例。采用Cox比例风险回归分析来估计胃癌死亡及其他原因死亡的相对风险，并对潜在的混杂因素进行校正。在男性中，参与筛查与胃癌死亡风险显著降低相关（相对风险[RR]=0.54；95%置信区间[CI]=0.41 - 0.70）。风险降低的程度大于潜在的健康选择因素（非胃癌死亡，RR = 0.71）。然而，对潜在混杂变量进行校正后，死亡风险的差异有所减弱（胃癌，RR = 0.65；其他原因，RR = 0.71）。在女性中，参与筛查与胃癌死亡之间的关联强度（RR = 0.74；95% CI = 0.52 - 1.07）与非胃癌死亡的关联强度相同（RR = 0.74）。亚组分析显示，有胃癌家族史的女性因筛查而降低了胃癌死亡风险（RR = 0.32；9�% CI = 0.12 - 0.87）。目前的结果强调了观察性研究中存在选择偏倚的可能性，因此胃癌筛查是否有效仍是一个悬而未决的问题。
