2013-2015年上海市浦东新区居民大肠癌筛查全结肠镜检查结果分析

摘要

目的 分析上海市浦东新区居民大肠癌筛查全结肠镜检查情况,为优化大肠癌筛查策略提供参考.方法 以2013-2015年上海市浦东新区参加大肠癌筛查项目肠镜检查的居民为研究对象,将检出有癌前期病变及大肠癌的患者作为病例组,其他为对照组,比较两组之间年龄、性别、户籍地和婚姻状况等信息的差异,并分析危险度、粪便潜血检测试纸(FOBT)及两者并联筛查的效益.结果 2013-2015年浦东新区有20 084人参加大肠癌筛查项目的全结肠镜检查,共检出2 456例肠镜阳性者,两组人群存在性别、年龄和筛查年份差异,男性(15.44％)多于女性(9.61％).筛查起始年(2013年)(15.20％)多于其他年份,非目标人群(＜50岁或＞74岁)(16.57％)多于目标人群(50 ～74岁)(11.88％);以肠镜检查为金标准,危险度评估灵敏度为24.39％,特异度为66.84％,阳性预测值为9.29％,阴性预测值为86.38％,一致率为61.65％;FOBT检测灵敏度为86.12％,特异度为22.75％,阳性预测值为13.44％,阴性预测值为92.16％,一致率为31.50％;社区初筛(并联筛查)灵敏度为97.52％,特异度为2.00％,阳性预测值为12.18％,阴性预测值为85.23％,一致率为13.68％.结论 大肠癌筛查项目让浦东新区社区居民获益,提示在关注高危人群的同时,容纳非目标人群自愿参与筛查,并采取一定措施优化风险评估策略,可提高筛查效益.%Objective To analyze the results of colonoscope in colorectal cancer screening in residents in Pudong new district of Shanghai and provide evidence for the improvement of screening.Methods The residents receiving enteroscope in colorectal cancer screening in Pudong of Shanghai from 2013 to 2015 were recruited in this analysis.Patients with pre-cancerous lesions or colorectal cancer detected in enteroscope were divided into the positive group,and others in negative group.The differences in age,gender,address and marital status between the two groups were compared,and the efficiency of risk assessment,fecal occult blood test (FOBT),and combined protocol were analyzed.Results In 20 084 people receiving enteroscope in Pudong during this period,2 456 cases of pre-cancerous lesions or colorectal cancer were detected,there were significance difference in gender and age distributions and screening time between two groups.The positive rate in men (15.44％) was higher than that in women (9.61％),the positive rate in those receiving screening in 2013 (15.20％) was higher than those in other years,and the positive rate in non-targeted population (＜ 50 years old or ＞ 74 years) (16.57％) was higher than that in targeted population (50-74 years) (11.88％);Compared with enteroseope,the sensitivity,specificity,positive predictive value,negative predictive value,negative predictive value,and the concordance rate the concordance rate were 97.52％,2.00％,12.18％,85.23％,and 13.68％,respectively,for community early screening,24.39％,66.84％,9.29％,86.38％ and 61.65％,respectively,for risk assessment,and 86.12％,22.75％,13.44％,92.16％ and 31.50％,respectively,for FOBT.Conclusion Colorectal cancer screening benefited the health of the residents in Pudong,but the risk assessment needs to be improved,and the involvement of non-targeted population would improve the efficiency of the screening.