Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Epidemiology, Cancer Institute/Hospital of Cixian, Cixian, China.
Cancer Sci. 2018 Jun;109(6):1995-2002. doi: 10.1111/cas.13606. Epub 2018 Apr 29.
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.
内镜筛查食管癌的疗效尚不确定，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分期分布，证明了短期筛查的疗效。林州和磁县的村庄采用整群随机分配方法分为干预组和对照组，目标人群分别为 52729 人和 43068 人，年龄在 40-69 岁之间，实际入组人数分别为 18316 人和 21178 人。收集了 2012 年至 2016 年食管癌病例的 TNM 分期信息和研究定义的分期信息。在总目标人群中以及根据入组情况和干预前后，比较了干预组和对照组之间的分期分布。干预组和对照组分别有 199 例和 141 例食管癌病例。对于目标人群，干预后两组之间的 TNM 分期分布存在边缘显著差异（P=.093）。然而，干预后入组人群的亚组分析在 TNM 和研究定义的分期方面均具有统计学意义。自然 TNM 分期分布在 I-IV 期分别为 32%、41%、24%和 3%，而干预组分别为 71%、19%、7%和 3%。自然研究定义的早期、中期和晚期分期分布分别约为 18%、49%和 33%，而干预组分别为 59%、33%和 8%。内镜筛查后早期食管癌病例所占比例较高，目标人群的疗效取决于干预的依从性。
