中等风险国家胃癌内镜筛查的有效性——一项系统评价与荟萃分析
Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries-A Systematic Review and Meta-Analysis.
作者信息
Mourato M B, Pratas N, Branco Pereira A, Chança R, Fronteira I, Dinis R, Areia M
机构信息
NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, LA-REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal.
Unidade Local de Saúde do Alto Alentejo, Hospital Doutor José Maria Grande, Portalegre, Portugal.
出版信息
United European Gastroenterol J. 2025 Aug 2. doi: 10.1002/ueg2.70084.
BACKGROUND
Gastric cancer remains a major cause of cancer-related mortality in intermediate-risk countries. Although endoscopic screening is widely implemented in high-risk regions, its effectiveness and economic viability in intermediate-risk settings remain uncertain. This systematic review and meta-analysis evaluated the effectiveness and cost-effectiveness of endoscopic screening in these countries.
METHODS
A systematic review and meta-analysis was conducted to assess the effectiveness and cost-effectiveness of upper gastrointestinal endoscopic screening by esophagogastroduodenoscopy (EGD) for gastric cancer. Searches were performed in Medline, Scopus, Embase, and Web of Science up to 30 September 2024. Pooled estimates were calculated for the detection of precancerous conditions, gastric cancer (overall and early-stage), and gastric cancer-specific mortality. Subgroup analyses were performed by screening strategy and geographic setting.
RESULTS
Thirty-two studies met inclusion criteria-24 on screening effectiveness and eight on cost-effectiveness. Among 404,159 individuals screened, the pooled detection rate for precancerous conditions was 25.5%, for gastric neoplastic lesions 3.3%, and for early-stage cancer among neoplastic cases 91.6%. Gastric cancer-specific mortality was 26.1%, and 5-year survival reached 75.7%. Subgroup analyses of studies using direct EGD versus pre-selection indicated higher detection of precancerous conditions (32.5% vs. 17.0%, p < 0.001) and early-stage cancer (95.8% vs. 87.3%, p < 0.001). Comparing Chinese versus other settings, similar detection rates were found for precancerous conditions (25.3% vs. 26.0%) and early-stage detection (91.5% vs. 100%). Economic analyses suggest that endoscopic screening is cost-effective in intermediate-risk settings, particularly when combined with colorectal screening, with incremental cost-effectiveness ratios within accepted willingness-to-pay thresholds.
CONCLUSIONS
Endoscopic screening by EGD shows strong potential for early detection of gastric cancer in intermediate-risk countries. However, formal comparative analyses with unscreened populations are lacking, and most survival and mortality data originate from Chinese studies, limiting generalizability. Nevertheless, economic evaluations suggest implementing endoscopic screening-especially when integrated with colorectal screening or guided by risk stratification-could be a feasible and effective strategy.
TRIAL REGISTRATION
PROSPERO-CRD42024502174.
背景
在中等风险国家，胃癌仍是癌症相关死亡的主要原因。尽管内镜筛查在高风险地区广泛实施，但其在中等风险地区的有效性和经济可行性仍不确定。本系统评价和荟萃分析评估了这些国家内镜筛查的有效性和成本效益。
方法
进行了一项系统评价和荟萃分析，以评估通过食管胃十二指肠镜检查（EGD）进行上消化道内镜筛查对胃癌的有效性和成本效益。截至2024年9月30日，在Medline、Scopus、Embase和科学网进行了检索。计算了癌前病变、胃癌（总体和早期）以及胃癌特异性死亡率检测的合并估计值。按筛查策略和地理区域进行亚组分析。
结果
32项研究符合纳入标准——24项关于筛查有效性，8项关于成本效益。在404,159名接受筛查的个体中，癌前病变的合并检出率为25.5%，胃肿瘤性病变为3.3%，肿瘤病例中早期癌症为91.6%。胃癌特异性死亡率为26.1%，5年生存率达到75.7%。对使用直接EGD与预筛选的研究进行亚组分析表明，癌前病变（32.5%对17.0%，p<0.001）和早期癌症（95.8%对87.3%，p<0.001）的检出率更高。比较中国与其他地区，癌前病变（25.3%对26.0%）和早期检出（91.5%对100%）的检出率相似。经济分析表明，内镜筛查在中等风险地区具有成本效益，特别是与结直肠癌筛查相结合时，增量成本效益比在可接受的支付意愿阈值范围内。
结论
EGD内镜筛查在中等风险国家显示出早期发现胃癌的强大潜力。然而，缺乏与未筛查人群的正式比较分析，且大多数生存和死亡率数据来自中国研究，限制了普遍性。尽管如此，经济评估表明，实施内镜筛查——特别是与结直肠癌筛查相结合或根据风险分层进行指导时——可能是一种可行且有效的策略。
试验注册
PROSPERO-CRD42024502174。
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