食管癌高发区人群贲门癌及腺上皮异型变检出率分析

[目的]了解食管癌高发区高危人群的贲门早期癌及癌前病变的存在状况。[方法]在目标人群中对8432例40～69岁的人群中的6048例进行了内镜筛查,在贲门脊根部取材活检。[结果]发现贲门癌55例,贲门腺上皮重度增生65例,检出率分别为0．91％和1．07％。[结论]食管癌高发区贲门癌同样高发,贲门脊根部常规咬检可提高早期贲门癌及癌前病变的检出率。     

2006—2015年四川省盐亭县上消化道癌发病与内镜筛查结果对比分析

摘 要：［目的］ 对比分析我国食管癌高发区四川省盐亭县2006—2015年间,上消化道癌发病情况及高危人群上消化道癌内镜检出情况,为下一步明确人群防治工作的重点提供理论依据。［方法］ 将盐亭县40～69岁设为内镜筛查目标人群,对其采用内镜下碘染色及指示性活检进行筛查,统计分析目标人群早期食管癌、贲门癌、远端胃癌及相应癌前病变的检出情况;依托肿瘤登记数据,分析2006—2015年间盐亭县远端胃癌、贲门癌及食管癌发病情况。［结果］ 2006—2015年盐亭县肿瘤登记结果显示,十年期间,盐亭县40～69岁人群中胃癌发病率最高,约为食管癌的1.13倍（445.13/10万vs 393.4/10万）,其中远端胃癌发病率约占总胃癌发病率的3/4;内镜筛查42 340人,盐亭县40～69岁人群早期食管癌及癌前病变检出率显著高于早期胃部病变检出率（0.66% vs 0.28%）,其中远端胃部早期癌及癌前病变检出率略高于贲门部（0.15% vs 0.13%）;对6048例贲门黏膜无异常者进行高发位点的常规性活检,发现13例早期贲门癌癌变患者,检出率为0.21%,高于指示活检的0.12%。［结论］ 盐亭县胃癌发病率高于食管癌,远端胃癌是盐亭县胃癌主要类型,且发病率高,检出率低,下一步工作重心应放在提高早期胃癌及癌前病变的筛查及诊断水平上。     

磁县食管癌高发区贲门癌及其癌前病变检出率分析

[目的]探讨磁县食管癌高发区居民贲门癌及其癌前病变的分布情况。[方法]回顾整理磁县2005~2009年40~69岁高危人群的内镜筛查资料,按性别,年龄统计贲门癌及其癌前病变的检出率。[结果]纳入分析普查对象11 423人,贲门活检率95.71%。贲门低级别上皮内肿瘤检出率为2.07%,高级别上皮内肿瘤为0.30%,黏膜内腺癌为0.23%、浸润性腺癌为0.18%。各级别病变检出率男性均高于女性,并且随年龄的增高病变检出率增加。[结论]磁县食管癌高发区40~69岁人群存在无症状贲门癌及其癌前病变的患者,年龄和性别与检出率关系密切。食管癌高发区上消化道癌筛查应重视贲门部位的检查。     

食管癌高发区人群内镜筛查

[目的]探讨在高发区高危人群中发现早期癌及癌前病变的有效途径。[方法]林州市“食管癌早诊早治示范基地”依据中国癌症基金会对基地高危人群筛查方案．2005～2007年在林州市合涧镇的目标人群中按照顺应性70％的要求,对8432例40～69岁的6048例人群进行了内镜＋食管碘染色＋指示性活检和贲门脊根部活检。[结果]发现癌症患者100例,其中食管癌38例,贲门癌54例,胃癌7例,下咽癌1例．其中早期癌83例．检出率1．65％;癌前病变（高级别上皮内瘤变）148例,检出率2．45％。[结论]提高高危人群对癌症的认知度,推广食管碘染色和贲门脊根部常规活检技术．是提高食管贲门癌早期发现的关键。     

涉县、林州、阳城、磁县上消化道癌集中高发的分析

[目的]探讨食管癌高发区上消化道癌集中高发对病因和预防的启示。[方法]分析涉县、林州、阳城、磁县1998～2002年男女性食管、贲门、非贲门胃癌的发病率。[结果]在涉县、林州、阳城、磁县，食管、贲门、非贲门胃癌发病率的合计男性高达173．5／10万-281．9／10万，女性高达111．5／10万～152．8／10万．男性占到全身恶性肿瘤的70．3％～81．1％，女性占到全身恶性肿瘤的49.3％～75．5％。但这三种癌的相对比例存在地区间差异：涉县以贲门和非贲门的胃癌多见，占上消化道癌的60％以上：而磁县以食管癌多见，占70％以上；林州和阳城食管癌和胃癌各占约50％。[结论]应该把该地域当作上消化道癌高发区来认识，在努力寻找能标定个体风险或早期事件的生物学指标的同时，通过大规模改良饮水，降低高发区人群对亚硝胺的暴露水平，也许有助于更快降低发病率。     

应用内镜普查研究食管癌高发区贲门癌的发病情况

目的：了解食管癌高发区贲门癌的发病情况。制定更为有效的预防策略。方法：在食管癌高发区应用电子内镜直接碘染色检查法对高危人群共行3次内镜普查。结果：1）贲门癌的癌前病变即贲门腺上皮重度不典型增生的检出率为0.62%-1.50%。2）早期贲门癌的检出率分别为0.44%,0.68%及0.64%。中晚期贲门癌检出率分别为0.22%,0.17%及0.21%。3）91.30%-95.00%贲门重度不典型增生及早期贲门癌病变位于贲门时钟位（顺时针）10点位-2点位，大多数贲门癌前病变及早期贲门癌内镜下主要表现为贲门粘膜糜烂或浅溃疡。4）食管癌与贲门癌检出率之比为2.4-4.1:1。结论：在食管癌高发区直接应用内镜进行普查。除对食管癌及其癌前病变有较高的检出率外。对贲门癌及其癌前病变也有较高的检出率。因此在食管癌高发区也应重视贲门癌的防治及研究工作。     

2006-2012年山东省肥城市食管癌和贲门癌内镜筛查结果分析

目的：探讨食管癌高发区农村居民食管癌和贲门癌及其各级癌前病变的患病情况。方法2006—2012年在食管癌高发区山东省肥城市部分乡镇采用整群随机抽样的方法,选取部分自然村40～69岁农村居民作为筛查对象,对其采用内镜下碘染色及指示性活检进行筛查,并行病理诊断。结果2006—2012年肥城市共完成24759人次筛查,食管、贲门阳性病例检出率分别为1．37％和0．42％,早诊率分别为84．71％和65．05％,治疗率分别为92．65％和92．23％;男性食管、贲门各级病变的检出率高于女性（ P＜0．05）,且食管、贲门各级病变的检出率均随着受检者年龄的增长而增加。时间趋势分析显示,肥城市食管、贲门各级病变的检出率无明显增加或减少趋势,食管病变的检出率高于贲门病变。结论肥城市人群中存在相当数量的癌前病变患者,男性和老年人是食管癌（贲门癌）防治的重点人群。内镜碘染色可有效地提高食管癌（贲门癌）及其癌前病变的检出率,筛查中贲门脊根部必须重点观察,以提高人群贲门早期病变的检出率。     

太行山脉食管癌高发区内镜队列筛查分析与思考

分析河北磁县、涉县、河南林州这三个太行山脉食管癌高发区的10960例内镜队列筛查结果．提示传统的食管癌高发区存在着贲门腺癌的高发；内镜筛查对食管鳞癌的敏感性高于贲门腺癌：要降低高发区发病率和死亡率，必须重视和提高早期贲门腺癌的内镜诊断。     

食管癌高发区内镜碘染色筛查食管癌/贲门癌的5年结果分析

[目的]分析山西省阳城县食管癌/贲门癌早诊早治项目点的人群筛查资料,评价基层医生采用内镜碘染色筛查高发区食管癌/贲门癌及其癌前病变的效果。[方法]2006~2010年采用内镜碘染色法对40~69岁人群进行食管癌/贲门癌筛查,前4年对阳性病变和脊根部均取活检并进行病理学诊断,2010年筛查方法未要求脊根部取活检,该处为重点观察。[结果]2006~2010年,共筛查了7 094人,平均年龄为50.19岁,筛查人群平均参与率为70.74%。轻度不典型增生、中度不典型增生、重度不典型增生、早期癌及浸润癌的检出率分别为11.95%(848例)、2.44%(173例)、1.16%(82例)、0.15%(11例)、0.58%(41例)。第2年筛查检出率均高于第1年,2008年检出率明显高于首次筛查(χ2=7.105,P=0.008)。对于贲门部的检查,由于2010年脊根部不取活检,重度不典型增生、早期癌检出率较低,但与2009年相比无显著性差异(χ2=1.802,P=0.180),但轻度不典型增生检出率有显著性差异(χ2=33.87,P<0.01)。[结论]内镜碘染色法在高发区能筛查出早期食管癌/贲门癌癌前病变。用内镜碘染色筛查方法开展食管癌/贲门癌及其癌前病变的筛查是可行的。筛查中脊根部必须重点观察,该部位的活检可提高人群贲门早期病变的检出率。     

非高发区食管癌筛查人群食管病理分布

摘 要：［目的］探讨非高发区食管癌筛查人群的食管病理分布,评价食管癌筛查检出效果。［方法］采用整群抽样的方法,以食管癌发病率不高于河南省平均发病水平的3个县/市为研究现场,对当地40～69岁居民进行风险问卷评估,对高危人群开展以食管碘染色及指示性活检为技术的食管内镜检查,并对内镜下异常的病变进行病理活检确诊。诊断结果以病理结果为标准。描述不同性别及年龄组人群食管病理分布。［结果］ 参加食管癌内镜筛查人数23 733人,进行活检人数13 679人,活检率57.64%。食管疾病发病率由高到低依次为食管炎性疾病、鳞状上皮轻度异型增生、鳞状上皮中度异型增生、鳞状上皮重度异型增生、食管早期癌、浸润癌。食管各类病变发病率随年龄增长而增加,且在男性人群中发病率均高于女性。内镜活检病理人群中,各类食管异常病理占比39.92%,癌前病变及食管癌占比7.28%,早期癌及以上病变占0.69%。内镜筛查人群中,各类食管异常病理占23.00%,癌前病变及食管癌占4.19%,早期癌及以上病变占0.39%。［结论］ 内镜下碘染色技术用于非高发区人群食管癌筛查,阳性检出率明显低于高发区食管癌筛查检出率。非高发区人群的食管癌筛查策略需要进一步改进。     

EPIDEMIC STRENGTH OF CARDIA AND DISTANT STOMACH CANCER IN THE HIGH RISK REGION OF ESOPHAGEAL CANCER AND THEIR IMPLICATION TO EDOSCOPIC SCREENING

Objective： To discuss the epidemic strength of cardia and distant stomach cancers in the high risk region of esophageal cancer along the south Taihang mountain such as in Shexian, Linxian, and Cixian Counties, and to clarify the tasks for the control of upper gastrointestinal tract cancer as a whole in the region. Methods： Comparisons of incidence and mortality rates of esophageal, cardia and stomach cancers were made between Cixian, Linxian and Shexian Counties with reference to detection rates of cancer in situ and precancerous lesions of the three upper gastrointestinal cancers by endoscopic screening. The screening was performed from 1999 through 2004 in the three adjacent counties including a total of 6233 local residents aged 40 to 69 years old. Results： The incidence rates for cardia cancer for the male and female from 2000 through 2004 were 69.9 and 41.5, and the mortality rates were 54.3 and 33.2 respectively in Shexian County. Esophageal, cardia, and stomach cancers constitute about 70～80 percent of all malignant disease by incidence or mortality rates. Endoscopic survey with iodine staining can effectively detect squamous cell precancerous lesions in the esophagus, but the method is inadequate for the detection of adeno precancerous lesions of the cardia and stomach. Conclusion： The south Taihang mountain region is a high risk area not only for esophagus cancer, but also for cardia and stomach cancers. To control upper gastrointestinal tract cancers as a whole in the region, special attention should be paid to the control of cardia and stomach cancers. Presently, to find effective screening methods for detecting cardia and stomach precancerous lesions is especially important.     

山西省阳城县5073例上消化道内窥镜筛查结果分析

目的总结阳城县食管癌早诊早治项目内窥镜筛查情况和早期诊断结果。方法对5073例应用内窥镜检查＋碘染色＋指示性活组织检查及贲门脊根部定点活组织检查的普查资料进行分析。结果参加筛查的男女比为0．99：1,两组差异无统计学意义（P〉0．05）;不典型增生和癌的检出率男性明显高于女性（P〈0．01）;食管、贲门、胃的早期诊断率{早期诊断病例[重度不典型增生和（或）原位癌、黏膜内癌1／重度不典型增生和（或）原位癌以上病例）分别为73．33％、71．88％、44．44％。结论在食管癌高发区应用内窥镜检查＋碘染色＋指示性活组织检查可提高食管癌癌前病变的检出率,同时要重视对早期贲门癌的诊断,建议食管癌高发区常规内窥镜检查时应做碘染色＋指示性活组织检查和对贲门脊根部的定点活组织检查,以提高癌前病变的检出率。     

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background

Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province.

Methods

Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group (0, 1-4, 5-9, 10-14…80+). Incidence and mortality rates were age-standardized to World Segi’s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county.

Results

The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 (males, 42.18/100,000 and females, 24.31/100,000). The age-standardized rate by world standard population (ASRW) was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 (males, 31.40/100,000 and females, 18.45/100,000), ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 (ASRW =48.69/100,000) to 2004-2005 (ASRW =28.02/100,000), with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes (APC) of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011.

Conclusions

Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.     

Report of incidence and mortality in China Cancer Registries, 2008

Objective: Annual cancer incidence and mortality in 2008 were provided by National Central Cancer Registry in China, which data were collected from population‐based cancer registries in 2011. Methods: There were 56 registries submitted their data in 2008. After checking and evaluating the data quality, total 41 registries’ data were accepted and pooled for analysis. Incidence and mortality rates by area (urban or rural areas) were assessed, as well as the age‐ and sex‐specific rates, age‐standardized rates, proportions and cumulative rate. Results: The coverage population of the 41 registries was 66,138,784 with 52,158,495 in urban areas and 13,980,289 in rural areas. There were 197,833 new cancer cases and 122,136 deaths in cancer with mortality to incidence ratio of 0.62. The morphological verified rate was 69.33%, and 2.23% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 299.12/100,000 (330.16/100,000 in male and 267.56/100,000 in female) and the age‐standardized incidence rates by Chinese standard population (ASIRC) and world standard population (ASIRW) were 148.75/100,000 and 194.99/100,000, respectively. The cumulative incidence rate (0-74 years old) was of 22.27%. The crude incidence rate in urban areas was higher than that in rural areas. However, after adjusted by age, the incidence rate in urban was lower than that in rural. The crude cancer mortality was 184.67/100,000 (228.14/100,000 in male and 140.48/100,000 in female), and the age‐standardized mortality rates by Chinese standard population (ASMRC) and by world population were 84.36/100,000 and 114.32/100,000, respectively. The cumulative mortality rate (0-74 years old) was of 12.89%. Age‐adjusted mortality rates in urban areas were lower than that in rural areas. The most common cancer sites were lung, stomach, colon‐rectum, liver, esophagus, pancreas, brain, lymphoma, breast and cervix which accounted for 75% of all cancer incidence. Lung cancer was the leading cause of cancer death, followed by gastric cancer, liver cancer, esophageal cancer, colorectal cancer and pancreas cancer, which accounted for 80% of all cancer deaths. The cancer spectrum varied by areas and sex in rural areas, cancers from digestive system were more common, such as esophageal cancer, gastric cancer and liver cancer, while incidence rates of lung cancer and colorectal cancer were much higher in urban areas. In addition, breast cancer was the most common cancer in urban women followed by liver cancer, gastric cancer and colorectal cancer. Conclusion: Lung cancer, gastric cancer, colorectal cancer, liver cancer, esophageal cancer and female breast cancer contributed to the increased incidence of cancer, which should be paid more attention to in further national cancer prevention and control program. Different cancer control strategies should be carried out due to the varied cancer spectrum in different groups.     

食管癌高发区上消化道癌整体高发对病因及预防的启示

目的：探讨食管癌高发区食管癌和贲门癌集中高发对病因和预防的启示作用。方法：通过分析涉县、林州、阳城、磁县1988年1月至2002年12月年男女性食管、贲门、非贲门胃癌发病率的分布，揭示太行山南部食管癌高发区上消化道癌整体高发的特点，然后根据既往移民研究的结果、亚硝胺类动物诱癌的特点以及表观遗传流行病学和生物进化论的原理，对该地域上消化道癌的病因形成假说，并探讨通过改良饮水进行病因学预防的重要性。结果：涉县、林州、阳城、磁县食管、贲门、非贲门胃癌三者发病率的合计均占全身恶性肿瘤的70%～80%。纯山区的涉县以贲门和非贲门的胃腺癌多见，占上消化道癌60%以上；而山区、丘陵、平原各1/3的磁县以食管鳞癌多见，占70%以上；林州和阳城大部分为山区，食管鳞癌和胃腺癌各占约50%。高发区这种上消化道癌的部位构成随地势变化的现象与亚硝胺类动物诱癌实验的结果相似，可能与不同地势下亚硝胺的种类或丰度的差别有关。亚硝胺可通过先天启动、后天积累、二次促癌，以片起源或多点起源的方式导致上消化道癌整体高发。结论：太行山南部食管癌高发区存在环境致癌因素，在该地域寻找能标定个体风险或早期事件的生物学指标是一个今后应致力研究的方向，但通过先期改良饮水等病因预防措施也许有助于更快地把超额的发病率降低到国外人群的水平。     

2019年度广西上消化道癌机会性筛查结果分析

目的分析广西地区2019年度上消化道癌机会性筛查数据,为上消化道机会性筛查工作提供指导。方法回顾性分析从广西上消化道癌管理系统收集的2019年度(2019年7月1日—2020年6月30日)参加广西上消化道癌机会性筛查的临床病历资料。计算活检率,食管/胃肿瘤性病变检出率,食管癌/胃癌早诊率,并在不同性别组以及年龄组之间进行比较。结果共10357例受检者纳入上消化道癌机会性筛查,其中5897例进行活检组织病理学检查,食管、贲门、胃分别活检882例、178例、5392例,活检率分别为14.96%、3.02%、91.44%。共检出食管肿瘤性病变126例(1.22%),早期癌37例(29.37%);胃肿瘤性病变210例(2.03%),早期癌66例(31.43%);贲门肿瘤性病变19例(0.18%),早期癌4例(21.05%);胃及贲门肿瘤性病变229例(2.21%),胃及贲门早期癌70例(30.57%)。肿瘤性病变检出率在性别和年龄分组中比较,差异均有统计学意义(均P<0.001)。食管癌、胃癌早诊率在性别和年龄分组中比较,差异均无统计学意义(均P>0.05)。在80岁之前,食管、胃(包括贲门)肿瘤性病变的检出率均随年龄上升而上升(χ^(2)=46.716,P<0.001;χ^(2)=51.989,P<0.001)。结论2019年度广西上消化道癌机会性筛查检出率及早诊率均不高,需进一步提高人群的防癌意识,尤其是年龄≥40岁的男性人群。     

Cancer Occurrence in Semnan Province,Iran: Results of a Population-Based Cancer Registry

Introduction: suitable information of different cancers in special geographic areas can help define medical ‍programs for treatment and screening of high-risk groups. ‍Aims and Methods: The provincial health authority reported a high mortality rate from upper GI cancer in the ‍center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year ‍(1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on ‍histopathology, clinical or radiological findings, and death certificates. ‍Results: A total of 1732 patients with cancers (mean age 59.41%+19.08% years) were found during the study. Of ‍these, 936(54.86%) were in males. Crude rates were 124.8/100’000 and 112.1/100,000 for males and females, ‍respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100’000 and 136/100,000 ‍person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 ‍people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by ‍colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, ‍and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common ‍cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. ‍Conclusion: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence ‍rate reported from Iran up to now.     

2014年山西省肿瘤登记地区恶性肿瘤发病与死亡分析

目的探讨2014年山西省肿瘤登记地区恶性肿瘤发病与死亡情况。方法收集2014年全省12个肿瘤登记地区的数据资料,分析不同地区、不同年龄和性别的恶性肿瘤发病率与死亡率特点,同时与全国数据进行比较。结果2014年山西省肿瘤登记地区新发恶性肿瘤11703例(男性6559例,女性5144例),发病率为221.21/10万,中国人口标化发病率为163.91/10万,世界人口标化发病率为163.25/10万;城市地区发病率、中国人口标化发病率分别为247.02/10万、171.35/10万,农村地区分别为205.98/10万、159.03/10万。男性常见恶性肿瘤发病以胃癌、肺癌、食管癌、肝癌、结直肠癌为主,女性以乳腺癌、子宫颈癌、肺癌、食管癌、胃癌为主。恶性肿瘤死亡病例7283例(男性4548例,女性2735例),恶性肿瘤死亡率为137.66/10万,中国人口标化死亡率为99.67/10万,世界人口标化死亡率为100.11/10万;城市地区死亡率、中国人口标化死亡率分别为141.03/10万、92.84/10万,农村地区分别为135.68/10万、103.69/10万。男性常见恶性肿瘤死亡以肺癌、胃癌、肝癌、食管癌、结直肠癌为主,女性以肺癌、胃癌、肝癌、食管癌、子宫颈癌为主。结论山西省肿瘤登记地区恶性肿瘤发病与死亡均以肺癌、上消化道恶性肿瘤和女性子宫颈癌为主,胃癌、子宫颈癌的发病率较高。