基于风险的上消化道癌症筛查效果：一项多中心真实世界研究。
Effect of risk-based screening for upper gastrointestinal cancers: a multi-center real-world study.
作者信息
Tian Hongrui, Liu Mengfei, Liu Zhen, Shi Chao, Chen Lei, Zhang Yine, Li Mei, Li Xiaoli, Ma Yincheng, Ma Xiaoming, Liang Yingying, Shi Ruichun, Liu Hongli, Zheng Hongchen, Yang Wenlei, Pan Yaqi, Chen Huanyu, Lv Jinhan, He Zhonghu, Ke Yang
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China.
Ningxia Clinical Research Institute, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China.
出版信息
Br J Cancer. 2025 Aug 5. doi: 10.1038/s41416-025-03138-7.
BACKGROUND
To evaluate the feasibility, effectiveness, and cost-effectiveness of risk-based sequential screening for upper gastrointestinal (UGI) cancer via questionnaire-based quantitative models.
METHODS
We applied the risk-based screening strategy to the ongoing government-administered screening project in two areas (Longde and Litong) of Ningxia Hui Autonomous Region, China. Through epidemiological investigation, participants assessed as high-risk were invited for endoscopic screening.
RESULTS
A total of 9492 participants were enroled and completed questionnaire-based assessment, and 2552 (26.89%) participants were evaluated as high-risk. Among the high-risk subjects, 1198 (46.94%) individuals further received endoscopic examination. The detection rate of risk-based screening was 2.28 times as high as that of historical data of universal screening (p = 0.002) (Longde: 2.15% vs. 0.99%; Litong: 1.18% vs. 0.38%), with a similar early detection rate of ~60-70%. The average cost for detecting one case and the average cost for detecting one early case were 30.76% lower (Longde: $12,919 vs. $16,783; Litong: $21,836 vs. $45,512) and 28.99% lower (Longde: $20,993 vs. $24,475; Litong: $30,570 vs. $75,854), respectively, than those for universal screening.
CONCLUSIONS
This real-world, multi-centre study demonstrates that risk-based sequential screening is feasible and cost-effective in detecting UGI cancers, and is expected to be applied in other areas.
背景
通过基于问卷的定量模型评估基于风险的序贯筛查在上消化道（UGI）癌筛查中的可行性、有效性和成本效益。
方法
我们将基于风险的筛查策略应用于中国宁夏回族自治区两个地区（隆德和利通）正在进行的政府管理的筛查项目。通过流行病学调查，邀请评估为高风险的参与者进行内镜筛查。
结果
共有9492名参与者登记并完成了基于问卷的评估，2552名（26.89%）参与者被评估为高风险。在高风险受试者中，1198名（46.94%）个体进一步接受了内镜检查。基于风险的筛查的检出率是普遍筛查历史数据的2.28倍（p = 0.002）（隆德：2.15%对0.99%；利通：1.18%对0.38%），早期检出率相似，约为60%-70%。检测一例的平均成本和检测一例早期病例的平均成本分别比普遍筛查低30.76%（隆德：12,919美元对16,783美元；利通：21,836美元对45,512美元）和28.99%（隆德：20,993美元对24,475美元；利通：30,570美元对75,854美元）。
结论
这项真实世界的多中心研究表明，基于风险的序贯筛查在上消化道癌检测中是可行且具有成本效益的，有望在其他地区应用。
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