Jining NO.1 People's Hospital, Jining, China.
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Cancer Med. 2023 Jan;12(2):1791-1800. doi: 10.1002/cam4.4965. Epub 2022 Jun 30.
This study investigated the natural history of esophageal squamous cell carcinoma (ESCC) in rural Chinese. We sought to help provide more data to support ESCC screenings.
This study was based on an existing Screening Program in Feicheng, China. Esophageal precancerous lesions were identified in 1753 cases, diagnosed from esophageal cancer screenings from 2006 to 2016. We followed up with them through endoscopic screening until October 1, 2017. Pathology results from various grades of precancerous lesions were recorded and the annual transition probabilities and incidence density of ESCC were calculated.
As of October 1, 2017, a total of 4055.8 person-years has been observed. The ESCC incidence density of mild, moderate, and severe dysplasia (SD) was 0.17, 0.79, and 1.77 per 100 person-years, respectively. The median follow-up time of mild, moderate, and SD was 3.5, 2.3, and 2.2 years, respectively. The annual transition probability of mild, moderate, and SD to the next pathological level was 0.025, 0.038, and 0.016, respectively. The ESCC incidence density of males was 2.6 times higher than females (0.58 vs. 0.22), and the older age group (56-69 age group) had a ESCC incidence density 1.2 times higher than the younger group (40-55 age group) (0.45 vs. 0.39).
The higher the grade of precancerous lesions, the higher the incidence density of ESCC. Screening of esophageal cancer in males and the elderly should be strengthened. It is recommended to reinforce follow-up management for untreated patients with SD/carcinoma in situ. For patients with mild and moderate dysplasia in high-risk rural Chinese populations, endoscopic follow-up intervals can be appropriately adjusted to once every 2 years.
本研究旨在探究中国农村地区食管鳞状细胞癌（ESCC）的自然史。我们希望提供更多数据以支持 ESCC 筛查。
本研究基于中国肥城的一项现有筛查计划。2006 年至 2016 年，在食管癌筛查中发现了 1753 例食管癌前病变患者。我们通过内镜筛查对他们进行了随访，随访至 2017 年 10 月 1 日。记录了不同级别癌前病变的病理结果，并计算了 ESCC 的年转化率和发病率密度。
截至 2017 年 10 月 1 日，共观察到 4055.8 人年。轻度、中度和重度异型增生（SD）的 ESCC 发病率密度分别为 0.17、0.79 和 1.77/100 人年。轻度、中度和 SD 的中位随访时间分别为 3.5、2.3 和 2.2 年。轻度、中度和 SD 向更高病理级别转化的年转化率分别为 0.025、0.038 和 0.016。男性 ESCC 的发病率密度是女性的 2.6 倍（0.58 比 0.22），年龄较大的（56-69 岁年龄组）比年龄较小的（40-55 岁年龄组）ESCC 的发病率密度高 1.2 倍（0.45 比 0.39）。
癌前病变级别越高，ESCC 的发病率密度越高。应加强对男性和老年人的食管癌筛查。建议加强对未治疗的 SD/原位癌患者的随访管理。对于高危农村人群中患有轻度和中度异型增生的患者，内镜随访间隔可适当调整为每 2 年一次。
