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2005–2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究
作者:王孟 郝长青 赵德利 李变云 王进武 雷复华 周瑞雪 马山蕊 马箐 李琰琰 冯昊 李新庆 魏文强
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摘要:

目的  了解我国食管癌高发区食管癌及其癌前病变人群分布特征,为制定高发区食管癌及其癌前病变检出率参考值范围提供依据。方法  利用食管癌高发区建立的自然人群队列,回顾性整理2005–2009年中国食管癌高发区河南省林州市和山东省肥城市40~69岁参加内镜下碘染色筛查人群病理诊断数据,共15 709名,排除筛查前患有重要器官疾患者11例及病理诊断不明确者35例,进入分析的目标人群共15 663名。计算内镜筛查依从性,比较食管癌及其癌前病变性别、地区、年龄分布差异,采用95%CI值分析食管癌及各级别癌前病变检出率范围。结果  内镜筛查依从性为49.36%(15 709/31 826),女性(54.05%,8 447/15 628)依从性高于男性(44.83%,7 262/16 198)(χ2=88.14,P<0.001)。食管病变检出率为21.88%(3 427/15 663)。男性食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为4.17%(302/7 246)、17.22%(1 248/7 246)、1.67%(121/7 246)、0.83%(60/7 246),均高于女性[分别为3.45%(290/8 417)、14.82%(1 247/8 417)、1.41%(119/8 417)、0.48%(40/8 417)],且除高级别上皮内瘤变外,差异均有统计学意义(P值分别为0.018、< 0.001、0.960、0.006)。食管癌及各级癌前病变检出率均随年龄增加而增加(P值均<0.001),其中40~44岁调查对象食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为2.69% (94/3 500)、8.11%(284/3 500)、0.40%(14/3 500)和0.14%(5/3 500);65~69岁调查对象分别为5.46%(46/843)、23.25%(196/843)、3.68%(31/843)和2.14%(18/843)。林州市食管基底细胞增生、低级别上皮内瘤变、高级别上皮内瘤变、食管癌检出率分别为4.90%(504/10 287)、17.37%(1 787/10 287)、1.79%(184/10 287)、0.60%(62/10287),除食管癌外,均高于肥城市[分别为1.64%(88/5 376)、13.17%(708/5 376)、1.04%(56/5 376)、0.71%(38/5 376)](P值分别为<0.001、<0.001、<0.001、0.437)。食管癌及各级癌前病变检出率(95%CI值)分别为:基底细胞增生:3.78%(3.48%~4.08%);低级别上皮内瘤变:15.93%(15.37%~16.50%),其中轻度异型增生:12.31%(11.79%~12.82%),中度异型增生3.62%(3.33%~3.91%);高级别上皮内瘤变:1.53%(1.34%~1.72%);食管癌:0.64%(0.51%~0.76%)。结论  中国食管癌高发区自然人群中无症状癌前病变及癌症患者比例高达21.88%;年龄、性别与检出率密切相关;高发区食管癌内镜筛查应重视癌前病变的检出率,尤其要关注男性筛查对象内镜筛查依从性。

关键词:食管肿瘤;癌前状态;患病率

Abstract:

Objective  To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high- risk areas.Methods  Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005- 2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded.15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi- square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer.95% CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions.Results  The compliance rate of screening endoscopy of this study was 49.36% (15 709/31 826) of all, and female's compliance (54.05%, 8 447/15 628) was much higher than that of male (44.83%, 7 262/16 198) (χ2=88.14, P<0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17% (302/7 246),17.22% (1 248/7 246),1.67% (121/7 246),0.83% (60/7 246), and were higher than that of females (3.45% (290/8 417),14.82% (1 247/8 417),1.41%(119/8 417),0.48% (40/8 417), respectively). Except for high- grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018,< 0.001,0.960,0.006). The detection rates of all grades of precursor lesions increased with age rising (all P values <0.001), among which the detection rates of the mentioned four lesions for 40- 44 years old were 2.69% (94/3 500),8.11%(284/3 500),0.40% (14/3 500), 0.14% (5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were <0.001,<0.001,<0.001,0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90% (504/10 287),17.37% (1 787/10 287),1.79%(184/1 0287),0.60%(62/10 287) and 1.64% (88/5 376),13.17% (708/5 376),1.04% (56/5 376),0.71% (38/5 376).The 95% CI of detection rates of various lesions were, 3.78%(3.48%-4.08%) for basal cell hyperplasia, 15.93% (15.37%-16.50%) for low- grade intraepithelial neoplasia,12.31% (11.79%- 12.82%) for mild dysplasia and 3.62% (3.33%- 3.91%) for moderate hyperplasia, 1.53% (1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64% (0.51%-0.76%) for esophageal squamous cell cancer, respectively.Conclusion  Up to 21.88% residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high- risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.

Key words: Esophageal neoplasms;Precancerous conditions;Prevalence

发表日期:2015/8

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2015.08.003.T001:表1 2005–2009年河南省林州市、山东省肥城市40~69岁目标人群内镜筛查依从性

    10.3760/cma.j.issn.0253-9624.2015.08.003.T001:表1 2005–2009年河南省林州市、山东省肥城市40~69岁目标人群内镜筛查依从性

  • 10.3760/cma.j.issn.0253-9624.2015.08.003.T002:表2 2005–2009年河南省林州市、山东省肥城市不同特征调查对象患食管癌及其癌前病变检出情况

    10.3760/cma.j.issn.0253-9624.2015.08.003.T002:表2 2005–2009年河南省林州市、山东省肥城市不同特征调查对象患食管癌及其癌前病变检出情况

  • 10.3760/cma.j.issn.0253-9624.2015.08.003.T003:表3 2005–2009年河南省林州市、山东省肥城市男女食管癌及各级癌前病变检出率比较

    10.3760/cma.j.issn.0253-9624.2015.08.003.T003:表3 2005–2009年河南省林州市、山东省肥城市男女食管癌及各级癌前病变检出率比较

  • 10.3760/cma.j.issn.0253-9624.2015.08.003.F001:图1 2005–2009年河南省林州市、山东省肥城市食管癌及其癌前病变检出率年龄分布

    10.3760/cma.j.issn.0253-9624.2015.08.003.F001:图1 2005–2009年河南省林州市、山东省肥城市食管癌及其癌前病变检出率年龄分布

  • 10.3760/cma.j.issn.0253-9624.2015.08.003.T004:表4 2005–2009年河南省林州市与山东省肥城市食管癌及各级癌前病变检出率比较

    10.3760/cma.j.issn.0253-9624.2015.08.003.T004:表4 2005–2009年河南省林州市与山东省肥城市食管癌及各级癌前病变检出率比较

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