城市上消化道癌高危人群对内镜筛查的接受度与支付意愿

摘 要：［目的］ 调查我国城市上消化道癌高危人群对内镜筛查的接受度与支付意愿。［方法］ 基于 2012~2014年城市癌症早诊早治项目的13个省份,以高危风险模型筛查出的上消化道癌高危人群且接受进一步单一上消化道癌内镜筛查的居民为对象,面对面调查其对内镜筛查的接受度和在一定付费假设下的支付意愿,并进行分省份亚组分析。［结果］ 最终纳入分析对象共3256名。年龄（55.4±7.5）岁,男性占40.8%,近5年中位人均年收入为2.3万元。对于上消化道癌内镜筛查,90.0%的高危对象表示可以接受。假定将每3年1次的上消化道癌内镜筛查长期推行且需个人部分付费时,81.7%的高危对象表示愿意支付,但支付额度超过100元者仅占14.8%。其余18.3%无支付意愿者主要认为费用难以承受（38.2%）和检查痛苦（27.3%）。各省份间接受度和支付意愿存在统计学差异（P＜0.05）。［结论］ 我国城市上消化道癌高危人群对内镜筛查的接受度和支付意愿较高,但支付额度较低,提示应提高居民对内镜筛查认知和自我健康的责任意识,改善筛查环境和技术操作以减轻被筛者不适。     

定量粪便免疫化学试验筛查阈值对结直肠肿瘤早筛价值的影响

目的:分析定量粪便免疫化学试验（fecal immunochemistry test,FIT）筛查阈值对体检人群结直肠肿瘤早筛价值的影响。方法:以2017年07月至2021年06月在我院接受定量FIT检测并行肠镜检查的1 267例人群为研究对象,比较不同性质肿瘤的定量FIT数值和阳性率。通过Logistic 回归和受试者工作特征（receiver operating characteristic,ROC）曲线分析比较不同性别、年龄和不同阳性阈值下定量FIT对进展期肿瘤的筛检效能。结果:定量 FIT筛查阳性率为4.7%,阳性人群肠镜依从性为22.2%。结直肠癌患者的定量FIT数值高于进展期腺瘤和其他肠镜结果。当定量FIT水平为100~199 μg/L、200~299 μg/L、300~499 μg/L和500 μg/L以上时,患进展期肿瘤的风险分别是<100 μg/L时的4.296倍、4.121倍、6.506倍和10.474倍。不同阳性阈值下,FIT阳性组进展期肿瘤检出率均高于阴性组,且在男性和50~75岁人群中均有统计学差异。在100 μg/L时的比值比（odds ratio,OR）最大（总体OR=6.817,95%CI:2.727~17.040;男性OR=5.570,95%CI:2.198~14.115;50~75岁OR=10.178,95%CI:3.158~32.803）。此时,定量FIT对进展期肿瘤的灵敏度分别为94.7%、93.0%、96.2%,特异度分别为27.6%、29.6%、28.7%。当阳性阈值由100 μg/L升高至500 μg/L时,FIT诊断进展期肿瘤的灵敏度下降,特异度升高,但阳性预测值和阴性预测值变化不大。结论:定量FIT阳性阈值在100 μg/L时筛查进展期结直肠肿瘤的灵敏度较好,但特异度较低,是应用在体检人群伺机性筛查中较好的结直肠肿瘤早筛参考指标。     

粪便标志物检测在大肠癌筛查中的应用

大肠癌早期发生中常伴随基因突变、蛋白质和酶等分子代谢异常,通过检测粪便中基因、蛋白质和酶等标志物有助于大肠癌早期诊断。其中粪便K—ras、APC、p53、长片段DNA、DNA甲基化、钙卫蛋白（CPT）、微型染色体维持蛋白一2、促衰变因子、癌胚抗原（CEA）、Adnab-9和端粒酶、环氧合酶2（COX-2）、肿瘤M2型丙酮酸激酶（TUM2-PK）等在筛选大肠癌中取得了较大进展。     

粪便标志物检测在大肠癌筛查中的应用

大肠癌早期发生中常伴随基因突变、蛋白质和酶等分子代谢异常,通过检测粪便中基因、蛋白质和酶等标志物有助于大肠癌早期诊断。其中粪便K-ras、APC、p53、长片段DNA、DNA甲基化、钙卫蛋白(CPT)、微型染色体维持蛋白-2、促衰变因子、癌胚抗原(CEA)、Adnab-9和端粒酶、环氧合酶2 (COX-2)、肿瘤M2型丙酮酸激酶(TU M2-PK)等在筛选大肠癌中取得了较大进展。     

重庆城市居民对癌症筛查技术及组织形式接受度的调查研究

摘 要：［目的］ 对重庆市开展的上消化道癌、大肠癌、肝癌、肺癌和乳腺癌等五大类癌症的风险评估、临床筛查技术及筛查组织形式的接受度进行分析,为未来更大范围开展癌症早诊早治项目提供科学依据。［方法］ 采用横断面方便抽样方法,对2507名参加重庆城市癌症早诊早治项目的筛查个体进行筛查接受度问卷调查。［结果］ 70.86%的研究对象认为以问卷形式开展风险评估的初筛策略很好;78.88%的研究对象是通过社区医生或街道居委会工作人员了解该项目;91.82％的研究对象希望一次性就能将所有检查项目做完,但也有5.94％的研究对象希望将多项临床检查分在不同的日期进行。［结论］ 以问卷形式开展社区普通人群风险评估的初筛策略可行性较好,高危人群对不同临床筛查项目的接受度差异较大,临床筛查组织形式应有一定的灵活性。     

肿瘤患者对新药临床试验的认知度与接受度调查

[目的]了解肿瘤患者对新药临床试验的认知度和接受度现状。[方法]根据患者是否参与过临床试验,分别设计两份"肿瘤患者对临床试验的认知度和接受度"调查问卷,并于2010年8月～10月期间在中山大学肿瘤防治中心门诊和住院开展调查,共403名患者及家属完整回答问卷,并当场回收,随后统计分析。[结果]370名未参与过临床试验的肿瘤患者对临床试验的认知度和接受度普遍较低,甚至存在偏见和误解;但参加过临床试验的33名患者比从未参加的患者在认知度方面有所提高,但仍然对"随机"、"安慰剂"等概念认识模糊;接受度方面,78.5%的受调查者认为肿瘤临床试验对促进肿瘤研究及改善疗效有重要意义,大部分病人(75.8%)在结束临床试验后愿意将血液或者其它标本用于其它研究。[结论]目前我国肿瘤患者对临床试验的认知度和接受度均低,有待进一步提高。提高医护人员对临床试验的认知度和接受度是提高病患认知水平的重要途径;另外,加强网络、报刊等媒体宣传也是提高公众正确认识新药临床试验的关键。     

三种结直肠癌筛查评分模型在徐州市人群中诊断效果的验证与比较

摘 要：［目的］ 验证和比较亚太结直肠癌筛查(Asia-Pacific colorectal screening,APCS)评分、APCS评分修订版、结直肠肿瘤(colorectal neoplasm,CN)预测评分作为初筛手段在徐州市50~74岁无症状社区人群结直肠癌筛查中的效果。［方法］ 选择2017—2020年在徐州市参与结直肠癌筛查的50~74岁无症状社区居民作为研究对象,使用资格审核表评价研究对象的入组资格,所有符合条件的受试对象均签署知情同意书。使用APCS评分、APCS评分修订版、CN预测评分对符合条件的受试对象进行风险评分,分别记录评分结果和病变检出情况。比较各模型对进展期肿瘤(advanced neoplasm,AN)的诊断表现。 ［结果］ 共纳入符合条件受试对象1 328人,其中男性570人(42.92%),平均年龄（59.63±6.18）岁。人群中共检出AN 46例,检出率为3.46%。APCS评分、APCS评分修订版、CN预测评分评估高风险率分别为46.54%(618/1 328)、57.68%(766/1 328)、43.83%(582/1 328),APCS评分修订版高风险率高于APCS评分(χ2=33.05,P<0.001)和CN预测评分(χ2=51.00,P<0.001)。各模型评估高风险组中AN的检出率分别为4.21%(26/618)、4.70%(36/766)、4.81%(28/582),检出率间差异无统计学意义(χ2=0.29,P=0.864)。除APCS评分外,APCS评分修订版和CN预测评分高风险组的AN检出率均高于非高风险组(APCS评分修订版：χ2=8.27,P=0.004;CN预测评分：χ2=5.62,P=0.018),但与人群AN总检出率(3.46%)间差异均无统计学意义(APCS评分：χ2=0.65,P=0.419;APCS评分修订版：χ2=1.97,P=0.160;CN预测评分：χ2=1.97,P=0.160)。各模型对AN诊断的灵敏度分别为56.52%(95%CI：41.10%~71.07%)、78.26%(95%CI：63.64%~89.05%)、60.87%(95%CI：45.37%~74.91%),各模型间差异无统计学意义(χ2=5.37,P=0.068);特异度分别为53.82%(95%CI：51.05%~56.58%)、43.06%(95%CI：40.33%~45.82%)、56.79%(95%CI：54.02%~59.52%),APCS评分高于APCS评分修订版(χ2=29.74,P<0.001),但与CN预测评分差异无统计学意义(χ2=2.28,P=0.131),CN预测评分高于APCS评分修订版(χ2=48.32,P<0.001);AUC分别为0.55(95%CI：0.48~0.63)、0.61(95%CI：0.54~0.67)、0.59(95%CI：0.52~0.66),各模型间差异无统计学意义(χ2=3.07,P=0.215)。各评分模型评估高风险人群中每检出1例AN需要筛查和进行结肠镜检查的数量分别为24、21、21,均少于不进行初筛的结肠镜资源负载(29)。 ［结论］ 在徐州市50~74岁社区人群中使用APCS评分、APCS评分修订版、CN预测评分作为初筛手段的预测效果有待提升,但相比不进行初筛可以减少每检出1例AN所需的资源负载。若要使用风险评分模型作为初筛在徐州市进行大规模人群筛查,还需根据本地人群特征建立合适的风险评估模型。     

结直肠癌标志物粪便检测的研究现状

结直肠癌(CRC)标志物粪便检测主要有以下4种方法：粪便隐血试验、粪便DNA检测、粪便微小RNA检测、粪便具核梭杆菌(Fn)检测。免疫法粪便隐血试验已经被国内外专家共识推荐作为CRC筛查的首选方法。由于粪便DNA检测费用偏高,目前国内尚未进行大样本的人群筛查,被推荐为CRC筛查的第二级检查。粪便微小RNA检测逐渐受到学...     

粪便肿瘤M2型丙酮酸激酶检测对结直肠癌诊断价值的Meta分析

目的:通过Meta分析方法评价粪便中肿瘤M2型丙酮酸激酶(tumor M2-pyruvate kinase,tumor M2-PK)的检测对结直肠癌的诊断价值。方法:计算机检索Pubmed、Cochrane library、Medline、中国知网期刊数据库、万方数据库和维普数据库等电子数据库,纳入以tumor M2-PK诊断筛查结直肠癌的临床诊断学实验,提取特征信息。采用Meta-Disc1.4软件进行汇总分析,绘制综合受试者工作曲线(SROC)。结果:15个研究的汇总灵敏度为77%(95%CI:74%～80%),特异度为77%(95%CI:75%～79%),阳性似然比为4.14(95%CI:3.19～5.38),阴性似然比为0.29(95%CI:0.25～0.34),诊断比值比DOR为16.31(95%CI:11.28～23.58)。受试工作者特征曲线下面积SROC AUG为0.858 2,Q=0.789 0。结论:应用ELISA法检测粪便tumor M2-PK对结直肠癌的诊断效力中等,该非侵入性检测方法可作为结直肠癌诊断的一种辅助方法。     

沉默泡膜蛋白1对SW480细胞增殖与侵袭影响的研究

目的 泡膜蛋白1(vacuole membrane protein-1,VMP1)是近年来新发现的一个重要功能的抑癌基因.为明确VMP1在结直肠癌中的功能和意义,本研究通过慢病毒载体沉默结直肠癌细胞系SW480中VMP1基因的表达,探讨VMP1基因沉默后对结直肠癌细胞增殖、凋亡及迁移的调控作用.方法 应用RT-PCR及蛋白质印迹法检测5种结直肠癌细胞系中VMP1的表达状况;设计人VMP1基因的shRNA慢病毒载体,在293T细胞中包装病毒并感染VMP1高表达的结直肠癌细胞系,运用蛋白质印迹法鉴定其对VMP1基因的沉默效果;VMP1基因沉默后,通过MTT法和软琼脂克隆形成实验检测其对细胞增殖能力的影响,并应用流式细胞技术检测细胞凋亡;运用Transwell迁移实验检测细胞的体外侵袭迁移能力.结果 VMP1在5种细胞系中存在差异性表达.具有低转移潜能的HT-29和SW480细胞与具有高转移潜能的LoVo、RKO和SW620细胞相比,有更高的VMP1表达水平,其中mRNA表达差异有统计学意义,t=3.88,P=0.005;而蛋白表达差异有统计学意义,t=14.29,P＜0.001.选取低转移细胞株中VMP1表达相对较高的SW480细胞作为研究对象,构建VMP1 shRNA慢病毒载体沉默SW480细胞中VMP1的表达.蛋白质印迹结果提示,VMP1稳定沉默的SW480细胞构建成功.在稳定沉默VMP1基因后,MTT法显示SW480细胞的增殖速度在24和48 h显著升高,F值分别为79.77和12.35,P值分别为＜0.001和0.025.软琼脂克隆形成实验结果显示,SW480细胞的集落数目显著增多,F=75.23,P＜0.001.二者均表明SW480细胞增殖能力增强.流式细胞技术检测显示,VMP1基因沉默后可抑制SW480细胞凋亡,F=84.44,P＜0.001.Transwell迁移实验结果显示,VMP1沉默后SW480迁移能力增强,F=155.90,P＜0.001.结论 VMP1基因可能与结直肠癌的细胞增殖、凋亡与转移有关,进而参与了结直肠癌的发生、发展.     

The Accuracy of Fecal Immunochemical Test in Colorectal Cancer Screening: A Meta-Analysis

Objective: To investigate the accuracy of OC-Sensor and colorectal cancer screening in a population-based randomized controlled trial at Khon Kaen province, Thailand. Methods: The MOOSE Guidelines for Systematic Reviews and Meta-Analyses of Observational Studies was applied. Eligibility criteria were English language, hand searching was conducted using Medline databases from 2010 to 2021 for identify literatures reviews of OC-Sensor and colorectal cancer screening. The initials screen based on the research titles and abstracts, final screenings based on full-text reports. Synthesis the results with meta-analysis using fixed effect model, random effect model, determined statistically significant with p-value < 0.05.  Confirmed the pooled effect sizes of high heterogeneity by meta-regression including tested precision of each estimates by bubble plot using STATA version 14. Results: Meta-regression showed sensitivity of OC- sensor = 72.54% (95% CI: 65.82-79.25), and specificity of OC- sensor = 89.59% (95% CI: 87.23-91.95). Conclusions: Sample size and cut-off of fecal hemoglobin concentration in each study were differed but sub-group analysis and sensitivity analysis were not considered for this analysis because population, setting and location for detected cancer of included study are not differences.     

Knowledge,Acceptance, and Willingness to Pay for Human Papilloma Virus (HPV) Vaccination among Female Parents in Thailand

Background: This study aimed to examine the level of knowledge, attitude, acceptance, and willingness to pay (WTP) for HPV vaccination among female parents of girls aged 12-15 years in Thailand. Materials and Methods: A cross-sectional survey was conducted in eight schools across Bangkok. Results: Of 1,200 questionnaires sent out, a total of 861 questionnaires were received. Knowledge regarding the HPV vaccine among parents was quite low. Only half of the parents knew about the link between HPV and cervical cancer while one-third of them knew that the vaccine should be administered to the children before they become sexually active. Nevertheless, vaccine acceptance was high if it was offered for free: 76.9% for the bivalent and 74.4% for the quadrivalent vaccine. The proportion of respondents who were willing to copay for the vaccine if it was not totally free was also high, ranging from 68.9% for the bivalent to 67.3% for the quadrivalent vaccine. No significant difference between bivalent and quadrivalent vaccines in terms of prevalence of acceptance and willingness to pay was found. About one-third of the participants, who were willing to copay for the vaccine if it was not offered for free, indicated that they would copay less than 500 baht (30 baht = approx US$1) for three doses of bivalent vaccine. Conclusions: Substantial effort should be made to educate parents prior to introduction of a national HPV vaccination program. In terms of acceptance, either bivalent or quadrivalent vaccines can be recommended.     

粪便隐血试验与SDC2基因甲基化检测在结直肠癌筛查中的效果评价

[目的]比较粪便SDC2基因甲基化检测与粪便隐血试验用于人群结直肠癌筛查效果,为今后开展结直肠癌筛查技术及方案优化提供科学依据。[方法]以海宁市结直肠癌早诊早治筛查为平台,于2021年5月采用整群抽样方法抽取海宁市袁花镇3 000名40～74岁人群为研究对象,将SDC2基因甲基化检测纳入现有筛查路径,初筛包括结直肠癌风险评估、粪便隐血试验和SDC2基因甲基化检测,其中任一项阳性动员电子结肠镜检查,以结肠镜+病理结果为金标准判定筛查结果。[结果]共有2 664名对象完成结直肠癌风险评估并按要求同时送检了两份大便样品,其中男性1 303名,女性1 361名。单项粪便SDC2基因甲基化阳性为232例(8.71%),阳性者中116例(50.00%)完成肠镜检查;单项粪便隐血试验阳性为243例(9.12%),阳性者中126例(51.85%)完成结肠镜检查;粪便隐血试验和SDC2基因甲基化检测双阳性51例(Kappa=0.077,P=0.614),双阳性者中28例(54.90%)完成结肠镜检查,三组差异无统计学意义(χ²=0.452, P=0.798)。在单阳性组中,粪便隐血...     

Willingness to Pay for Colorectal Cancer Screening and Effect of Copayment in Southern Thailand

Background: The incidence rate of colorectal cancer in Thailand is increasing. Hence, the nationwide screeningprogramme with copayment is being considered. There are two proposed screening alternatives: annual fecalimmunochemical test (FIT) and once-in-10-year colonoscopy. A copayment for FIT is 60 Thai baht (THB) per test(≈ 1.7 USD); a copayment for colonoscopy is 2,300 THB per test (≈ 65.5 USD). Methods: The willingness to pay(WTP) technique, which is theoretically founded on a cost-benefit analysis, was used to assess an effect of copayment onthe uptake. Subjects were patients aged 50-69 years without cancer or screening experience. WTP for the proposedtests was elicited. Results: Nearly two thirds of subjects were willing to pay for FIT. Less than half of subjects werewilling to pay for colonoscopy. Among them, median WTP for both tests was greater than the proposed copayments.In a probit model, knowing CRC patient and presence of companion were associated with non-zero WTP for FIT.Presence of companion, female, and family history of cancer were associated with non-zero WTP for colonoscopy.After adjustment for starting price in the linear model, marital status, drinking behavior, and risk attitude were associatedwith WTP. None of factors was significant for colonoscopy. Uptake decreased as levels of copayment increased.At proposed copayments, the uptake rates of 59.8% and 21.6% were estimated for colonoscopy and FIT respectively.The demand for FIT was price inelastic; the demand for colonoscopy was price elastic. Estimates of optimal copaymentwere 62.1 THB for FIT and 460.2 THB for colonoscopy. At the optimal copayment, uptake rates would be 59.8%for FIT and 42.3% for colonoscopy.Conclusion(s): More subjects were willing to pay for FIT than for colonoscopy(59.0% versus 46.5%). The estimated uptake rates were 59.8% and 21.6% for colonoscopy and FIT at the proposedcopayments.     

Use of Fecal Immunochemical Tests in the Iowa Research Network

Although the fecal immunochemical test (FIT) has recently emerged as an effective and affordable colorectal cancer screening option, many family physician offices continue to use guaiac-based tests. The purpose of this study was to assess the use of FITs in the Iowa Research Network and to assess physicians' knowledge about FITs. A cover letter and questionnaire were faxed twice to the 291 physician members followed up by a mailing. One hundred and seven (37 %) questionnaires were returned. Participants' mean age was 55 years with 78 male responders. Fifty-two (49 %) of the physician's offices were in a nonmetro area. Fifty-one (49 %) reported using guaiac-based tests and 39 (39 %) reported using FITs. Many physicians were unsure of the answers for the FIT knowledge questions. FIT use is not widespread in Iowa Research Network physician offices, and not all physicians are aware of the type of fecal occult blood test being conducted in their office.     

Optimizing Screening for Colorectal Cancer: An Algorithm Combining Fecal Immunochemical Test,Blood-Based Cancer-Associated Proteins and Demographics to Reduce Colonoscopy Burden

BackgroundFecal Immunochemical Test (FIT) is widely used in population-based screening for colorectal cancer (CRC). This had led to major challenges regarding colonoscopy capacity. Methods to maintain high sensitivity without compromising the colonoscopy capacity are needed. This study investigates an algorithm that combines FIT result, blood-based biomarkers associated with CRC, and individual demographics, to triage subjects sent for colonoscopy among a FIT positive (FIT⁺) screening population and thereby reduce the colonoscopy burden.Materials and methodsFrom the Danish National Colorectal Cancer Screening Program, 4048 FIT⁺ (≥100 ng/mL Hemoglobin) subjects were included and analyzed for a panel of 9 cancer-associated biomarkers using the ARCHITECT i2000. Two algorithms were developed: 1) a predefined algorithm based on clinically available biomarkers: FIT, age, CEA, hsCRP and Ferritin; and 2) an exploratory algorithm adding additional biomarkers: TIMP-1, Pepsinogen-2, HE4, CyFra21-1, Galectin-3, B2M and sex to the predefined algorithm. The diagnostic performances for discriminating subjects with or without CRC in the 2 models were benchmarked against the FIT alone using logistic regression modeling.ResultsThe discrimination of CRC showed an area under the curve (AUC) of 73.7 (70.5-76.9) for the predefined model, 75.3 (72.1-78.4) for the exploratory model, and 68.9 (65.5-72.2) for FIT alone. Both models performed significantly better (P < .001) than the FIT model. The models were benchmarked vs. FIT at cutoffs of 100, 200, 300, 400, and 500 ng/mL Hemoglobin using corresponding numbers of true positives and false positives. All performance metrics were improved at all cutoffs.ConclusionA screening algorithm including a combination of FIT result, blood-based biomarkers and demographics outperforms FIT in discriminating subjects with or without CRC in a screening population with FIT results above 100 ng/mL Hemoglobin.     

全球HPV疫苗认知和接受状况的研究进展

为了解全球对HPV预防性疫苗的认识和接受程度,以便更好推动HPV疫苗在人群中的使用,文章通过回顾近年全球范围内发表的相关文献,对目前人群对HPV预防性疫苗的认识和接受程度进行综述研究。     

Advantages of Wordless Instructions on How to Complete a Fecal Immunochemical Test: Lessons from Patient Advisory Council Members of a Federally Qualified Health Center

Some patients face difficulty understanding instructions for completing the fecal immunochemical test (FIT), a self-administered test to screen for colorectal cancer. We sought to develop and test low-literacy instructions for completing the FIT. Working in partnership with a Latino-serving Federally Qualified Health Center (FQHC) in the Portland Metro area, we developed and tested low-literacy instructions for completing the FIT; the instructions contained seven words (mail within 3 days; Devolver dentro de 3 dias). We conducted focus groups of Spanish-speaking patients on the advisory council of our partnering FQHC organization, and we gathered feedback from the project's advisory board members and clinic staff. We mailed a FIT kit to each patient, along with either (a) instructions written in English and Spanish, consisting of 415 words; or (b) low-literacy “wordless” instructions. We asked patients to complete the test before providing feedback. Our qualitative assessment showed that the wordless instructions were preferred over instructions consisting of words. Wordless instructions might aid efforts to raise the rates of colorectal cancer screening among low-literacy and non-English-speaking populations.