Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China.
Linqu County People's Hospital, Linqu, China.
Endoscopy. 2022 Sep;54(9):848-858. doi: 10.1055/a-1728-5673. Epub 2021 Dec 28.
The effectiveness of endoscopic screening on gastric cancer has not been widely investigated in China and the screening interval of repeated screening has not been determined. METHODS : In a population-based prospective study, we included 375,800 individuals, 14,670 of whom underwent endoscopic screening (2012-2018). We assessed the associations between endoscopic screening and risk of incident gastric cancer and gastric cancer-specific mortality, and examined changes in overall survival and disease-specific survival following screening. The optimal screening interval for repeated endoscopy for early detection of gastric cancer was explored. RESULTS : Ever receiving endoscopic screening significantly decreased the risk of invasive gastric cancer (age- and sex-adjusted relative risk [RR] 0.69, 95 % confidence interval [CI] 0.52-0.92) and gastric cancer-specific mortality (RR 0.33, 95 %CI 0.20-0.56), particularly for noncardia gastric cancer. Repeated screening strengthened the beneficial effect on invasive gastric cancer-specific mortality of one-time screening. Among invasive gastric cancers, screening-detected individuals had significantly better overall survival (RR 0.18, 95 %CI 0.13-0.25) and disease-specific survival (RR 0.18, 95 %CI 0.13-0.25) than unscreened individuals, particularly for those receiving repeated endoscopy. For individuals with intestinal metaplasia or low grade intraepithelial neoplasia, repeated endoscopy at an interval of < 2 years, particularly within 1 year, significantly enhanced the detection of early gastric cancer, compared with repeated screening after 2 years (-trend = 0.02). CONCLUSION : Endoscopic screening prevented gastric cancer occurrence and death, and improved its prognosis in a population-based study. Repeated endoscopy enhanced the effectiveness. Screening interval should be based on gastric lesion severity.
内镜筛查在胃癌中的效果在中国尚未得到广泛研究，且重复筛查的间隔时间尚未确定。方法：在一项基于人群的前瞻性研究中，我们纳入了 375800 人，其中 14670 人接受了内镜筛查（2012-2018 年）。我们评估了内镜筛查与胃癌发病风险和胃癌特异性死亡率之间的关系，并检查了筛查后总体生存率和疾病特异性生存率的变化。还探讨了重复内镜检查以早期发现胃癌的最佳筛查间隔。结果：接受过内镜筛查与侵袭性胃癌（年龄和性别校正的相对风险 [RR] 0.69，95%置信区间 [CI] 0.52-0.92）和胃癌特异性死亡率（RR 0.33，95%CI 0.20-0.56）显著降低相关，特别是非贲门胃癌。重复筛查加强了一次性筛查对侵袭性胃癌特异性死亡率的有益作用。在侵袭性胃癌中，筛查检出者的总体生存率（RR 0.18，95%CI 0.13-0.25）和疾病特异性生存率（RR 0.18，95%CI 0.13-0.25）显著优于未筛查者，尤其是那些接受重复内镜检查者。对于肠上皮化生或低级别上皮内瘤变者，与 2 年后重复内镜检查相比，间隔时间<2 年、尤其是 1 年内重复内镜检查可显著提高早期胃癌的检出率（-趋势=0.02）。结论：在基于人群的研究中，内镜筛查可预防胃癌发生和死亡，并改善其预后。重复内镜检查可提高其效果。筛查间隔应基于胃病变严重程度。
