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2013年至2018年浙江省城市居民肝癌筛查结果及影响因素分析

[Analysis of liver cancer screening results and influencing factors of urban residents in Zhejiang Province from 2013 to 2018].

作者信息

Wang Y Q, Li H Z, Wang L, Zhu C, Sun X H, Zhang M Z, Jin L, Du L B

机构信息

The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital)/Institute of Basic Medicine and Cancer (IBMC). Chinese Academy of Sciences, Hangzhou 310022, China.

Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Mar 6;55(3):346-352. doi: 10.3760/cma.j.cn112150-20200818-01132.

Abstract

To analyze the results of liver cancer screening for urban residents in Zhejiang Province from 2013 to 2018 and explore the influencing factors of the detection rate. From September 2013 to August 2019, six urban communities in Hangzhou (Jianggan District and Gongshu District), Ningbo (Haishu District, Yinzhou District and Jiangbei District), and Quzhou (Kecheng District) were selected as study sites. All permanent residents aged 40-74 (with local household registration and living in the local area for more than 3 years) were selected as the research subjects by using cluster sampling method. Patients with confirmed cancers and other serious medical and surgical diseases were excluded. A total of 166 293 research subjects were included. Basic demographic characteristics and risk factors of subjects were obtained through questionnaire surveys. The cancer risk assessment system was used to evaluate the liver cancer risk of subjects. Clinical screening participation and screening results for subjects at high risk of liver cancer were obtained from participating hospitals. The high-risk rate of liver cancer, clinical screening rate, detection rate of positive lesions, and detection rate of suspected liver cancer were analyzed. Poisson regression was used to analyze the influencing factors of detection rate. The age of 166 293 subjects was (56.01±8.40) years, of which 41.36% (68 777) were males. A total of 23 765 high-risk subjects for liver cancer were screened (the high-risk rate was 14.29%). Among them, a total of 12 375 subjects participated in clinical screening for liver cancer, with a screening rate of 52.07% (12 375/23 765). A total of 297 cases of positive lesions were detected and the detection rate was 2.40% (297/12 375). A total of 8 cases of suspected liver cancer were detected, with a detection rate of 0.06% (8/12 375). The results of multivariate Poisson regression model analysis showed that compared with men, people who never smoked, never ate pickled food, had low oil content, and had no history of hepatobiliary disease, female, people who were smoking or had smoked, sometimes ate pickled food, ate higher oil content, and had a history of hepatobiliary disease had a higher detection rate of positive lesions. The incidence rate ratio () values were 1.98 (1.45-2.70), 2.23 (1.61-3.09)/2.08 (1.31-3.28), 1.82 (1.22-2.70), 1.44 (1.08-1.91), and 1.45 (1.05-2.00), respectively. Compared with those aged from 40 to 49 years old and without HBsAg test, the (95%) of suspected liver cancer in people aged 70 to 74 years old and HBsAg positive were 16.30 (1.32-200.74) and 6.43 (1.24-33.22), respectively. The urban cancer early diagnosis and early treatment project in Zhejiang Province has good compliance in clinical screening of liver cancer. Abdominal ultrasound examination and serum alpha-fetoprotein detection are helpful to detect liver cancer and its precancerous lesions in the high-risk population of liver cancer.

摘要

分析2013年至2018年浙江省城市居民肝癌筛查结果,探讨检出率的影响因素。2013年9月至2019年8月,选取杭州(江干区、拱墅区)、宁波(海曙区、鄞州区、江北区)和衢州(柯城区)的6个城市社区作为研究地点。采用整群抽样方法,选取所有年龄在40 - 74岁(具有当地户籍且在当地居住3年以上)的常住居民作为研究对象,排除确诊癌症及其他严重内科和外科疾病患者。共纳入166293名研究对象。通过问卷调查获取研究对象的基本人口学特征和危险因素,采用癌症风险评估系统评估研究对象的肝癌风险。从参与医院获取肝癌高危对象的临床筛查参与情况和筛查结果,分析肝癌高危率、临床筛查率、阳性病变检出率和疑似肝癌检出率。采用Poisson回归分析检出率的影响因素。166293名研究对象年龄为(56.01±8.40)岁,其中男性占41.36%(68777人)。共筛查出23765名肝癌高危对象(高危率为14.29%),其中共有12375名对象参与了肝癌临床筛查,筛查率为52.07%(12375/23765)。共检测出297例阳性病变,检出率为2.40%(297/12375)。共检测出8例疑似肝癌,检出率为0.06%(8/12375)。多因素Poisson回归模型分析结果显示,与男性相比,从不吸烟、从不吃腌制品、油脂摄入少且无肝胆疾病史的女性,以及吸烟或有吸烟史、有时吃腌制品、油脂摄入多且有肝胆疾病史的人群阳性病变检出率更高。发病率比(IRR)值分别为1.98(1.45 - 2.70)、2.23(1.61 - 3.09)/2.08(1.31 - 3.28)、1.82(1.22 - 2.70)、1.44(1.08 - 1.91)和1.45(1.05 - 2.00)。与40 - 49岁且未检测HBsAg的人群相比,70 - 74岁且HBsAg阳性人群疑似肝癌的IRR(95%CI)分别为16.30(1.32 - 200.74)和6.43(1.24 - 33.22)。浙江省城市癌症早诊早治项目在肝癌临床筛查方面具有良好的依从性。腹部超声检查和血清甲胎蛋白检测有助于在肝癌高危人群中检出肝癌及其癌前病变。

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