本文關鍵詞：中國食管癌高發(fā)區(qū)食管癌前病變分布特征及其進展規(guī)律研究　出處：《北京協(xié)和醫(yī)學院》2016年碩士論文　論文類型：學位論文

  更多相關文章： 食管癌 內(nèi)鏡篩查 依從性 檢出率參考值范圍 隨診間隔

【摘要】：研究目的基于河南林州、河北磁縣和山東肥城三個食管癌早診早治示范基地內(nèi)鏡篩查項目,描述我國食管癌高發(fā)區(qū)食管癌及其癌前病變分布、進展、發(fā)病/死亡規(guī)律,為制定不同級別癌前病變檢出率參考值范圍及隨診間隔,優(yōu)化現(xiàn)行食管癌早診早治項目技術方案提供科學依據(jù)。材料與方法本研究為基于自然人群的多中心橫斷面研究。依托我國食管癌高發(fā)區(qū)河南林州、河北磁縣、山東肥城2005年-2009年完成篩查的自然人群隊列,選擇40-69歲使用內(nèi)鏡下碘染色及指示性活檢技術進行篩查并有明確病理學診斷的篩查者為研究對象,回顧性整理其病理診斷結(jié)果。計算內(nèi)鏡篩查依從性,χ2檢驗比較食管癌及其癌前病變性別、地區(qū)、年齡分布差異,采用95%CI值分析食管癌及其癌前病變檢出率范圍。以2005-2009年進行內(nèi)鏡篩查、有明確病理診斷且未經(jīng)過治療的食管癌及其癌前病變患者為研究對象,進行二次內(nèi)鏡隨訪。計算兩次內(nèi)鏡時間間隔,并比較前后兩次內(nèi)鏡病理診斷結(jié)果,計算每年各級別癌前病變累積進展例數(shù)及累積進展概率,并進行性別、年齡別累積進展概率的比較。收集整理篩查覆蓋人群發(fā)病、死亡等終點結(jié)局資料,采用趨勢x2檢驗計算每一年不同級別病理診斷者累計發(fā)病、死亡率；x2檢驗比較各級別病理診斷研究對象中,不同性別、年齡別間發(fā)病率、死亡率的差別;對輕度不典型增生者3年累計發(fā)病率與其他每年累計發(fā)病率比較；對中度不典型增生者1年累計發(fā)病率與其他每年累計發(fā)病率比較。研究結(jié)果1.本研究覆蓋人群99060人,其中40-69歲人群46568人,首次參與內(nèi)鏡篩查人數(shù)為21955人,內(nèi)鏡篩查順應性為47.15%。其中女性(50.91%,11739/23058)依從性高于男性(43.45%,10216/23510)(x2=47.15,P0.001)。排除活檢組織過小不足以診斷191人,共計21764人納入本研究。食管病變檢出率為24.65%(5365/21764)。其中基底細胞增生1729例(7.94%,95% CI：7.59%-8.30%),低級別上皮內(nèi)瘤變3163例(14.53%,95%CI：14.06%-15.00%),高級別上皮內(nèi)瘤變335例(1.54%,95%CI：1.38%-1.70%),食管癌138例(0.63%,95%CI：0.53%-0.74%)。檢出率從高到低依次為：低級別上皮內(nèi)瘤變基底細胞增生高級別上皮內(nèi)瘤變食管癌。在食管癌及各級癌前病變中,男性檢出率均顯著高于女性�；准毎錾�、女檢出率分別為9.05%和6.98%(x2=19.438,P0.001)；低級別.上皮內(nèi)瘤變男、女檢出率分別為15.85%和13.38%(x2=26.661,P0.001)；高級別_上皮內(nèi)瘤變男、女檢出率分別為1.74%和1.37%(x2=4.865,P=0.027)；食管癌男、女檢出率分別為0.85%和0.45%(x2=13.829,P0.001)�；准毎錾�、低級別上皮內(nèi)瘤變、高級別上皮內(nèi)癌變和食管癌檢出率均有隨年齡增加而增加的趨勢,趨勢x2檢驗均有統(tǒng)計學意義。40～44歲調(diào)查對象各級別癌前病變檢出率最低,分別為7.61%(425/5585)、6.70%(374/5585)、0.34%(19/5585)和0.18%(10/5585)；65-69歲調(diào)查對象分別為8.14%(84/1093)、21.87%(239/1093)、3.84%(42/1093)和1.92%(21/1093)。并且在每一個年齡組中,檢出率由高到低均為低級別上皮內(nèi)瘤變基底細胞增生高級別上皮內(nèi)瘤變食管癌。林州、磁縣、肥城三地各級食管癌前病變檢出率均不同,其差別有統(tǒng)計學意義；其中,基底細胞增生檢出率磁縣最高,為18.57%(1136/6116).低級別上皮內(nèi)瘤變和高級別上皮內(nèi)瘤變檢出率均為林州最高,分別為17.40%(1787/10269)和1.80%(185/10269)。三地食管癌檢出率差別無統(tǒng)計學意義(Z2=0.613,P=0.736)。2.2005-2009年進行內(nèi)鏡篩查的人群共21955人,在9年里共計隨訪2389人,內(nèi)鏡篩查依從性為10.88%,其中男性內(nèi)鏡篩查依從性為11.26%,女性內(nèi)鏡篩查依從性為10.55%,二者差別無統(tǒng)計學意義(x2=0.096,P=0.099)。三個食管癌早診早治示范基地二次內(nèi)鏡篩查依從性均較低,其中,林州二次內(nèi)鏡篩查依從性最高,為15.81%,磁縣二次內(nèi)鏡篩查依從性最低,僅為4.5%。在隨訪的前七年,中度不典型增生累積進展率始終高于輕度不典型增生；隨訪第七年開始,二者累積進展率交叉。對于輕度不典型增生,2-4年累積進展率由0.18%進展為1.07%,累積進展率較低,且變化幅度不大,到第5年及以后每年進展率加快,均增長1個百分點以上；對于中度不典型增生,2-4年累積進展率較高,為3.33%-3.59%,但變化幅度不大,4-5年由3.59%進展為4.62%；對于低級別上皮內(nèi)瘤變,也有類似上述輕度不典型增生和中度不典型增生的規(guī)律。男性中度不典型增生隨訪2-9年累積進展率(5.29%-10.58%)始終大于輕度不典型增生(0.18%-7.18%)；女性中度不典型2-4年累積進展率高于輕度不典型增生,5年之后低于輕度不典型增生。各年齡組中,在隨訪最初,中度不典型增生累積進展率均顯著高于輕度不典型增生,隨后該差異逐漸減小,40-49歲組在隨訪第7年、50-59歲組在隨訪第8年,輕度不典型增生累積進展率開始高于中度不典型增生。3.在我國食管癌高發(fā)區(qū),內(nèi)鏡篩查并隨訪10年后,各級別病理診斷研究對象食管癌累計發(fā)病率/死亡率均呈上升趨勢,趨勢卡方檢驗均有統(tǒng)計學意義。在每一年中,發(fā)病率/死亡率大小均為中度不典型增生輕度不典型增生基底細胞增生正常。男性食管癌累計發(fā)病率/死亡率高于女性；食管癌累計發(fā)病率／死亡率隨年齡增加而增加。輕度不典型增生3年累計發(fā)病率與1-6年累計發(fā)病率比較,無顯著差異,(P0.05),直至第7年,二者比較差異有統(tǒng)計學意義(x2=5.286,P=0.021)；中度不典型增生1年累計發(fā)病率與2-4年累計發(fā)病率比較,無顯著差異(P0.05),直至第5年,二者比較差異有統(tǒng)計學意義x2=11.465,P=0.001。結(jié)論我國食管癌高發(fā)區(qū)自然人群中存在大量無癥狀癌前病變及癌癥患者,癌前病變檢出率與年齡、性別密切相關,高發(fā)區(qū)早診早治應進一步加強健康教育和組織發(fā)動,進一步提高癌前病變檢出率,尤其應提高男性以及高年齡篩查對象參加篩查依從性避免癌前病變漏診,從而提高篩查效果。中度不典型增生累積進展率及食管癌發(fā)生、死亡風險均高于輕度不典型增生。中度不典型增生累積進展率及食管癌發(fā)病、死亡率4年內(nèi)變化不大,輕度不典型增生累積進展率及食管癌發(fā)病、死亡率5年內(nèi)變化不大,建議對中度不典型增生3-4年進行一次隨訪,輕度不典型增生患者每5-6年進行一次隨訪。
[Abstract]:Based on the purpose of early diagnosis in Henan Linzhou, Hebei Cixian and Shandong Feicheng three esophageal cancer early treatment demonstration base of endoscopic screening project, described China's high incidence area of esophageal cancer esophageal cancer and its precancerous lesion distribution, pathogenesis, progress / death rules for different levels of precancerous lesions and the detection rate of the reference value range and follow-up interval optimization of early diagnosis of esophageal cancer, the early treatment project technical solutions and provide scientific basis for. Materials and methods this study was a multicenter cross-sectional study based on natural populations. Relying on China's high incidence area for esophageal cancer in Linzhou, Henan, Hebei Cixian, Shandong Feicheng in 2005 -2009 years to complete the screening queue natural population, aged 40-69 years old were chosen using iodine staining under endoscopy and biopsy technique for screening and definite pathological diagnosis screening as the research object, retrospectively collected the pathological diagnosis results. The compliance of endoscopic screening was calculated. Chi square test was used to compare the difference of sex, region and age distribution between esophageal cancer and precancerous lesion. The 95%CI value was used to analyze the detection rate of esophageal cancer and its precancerous lesions. The 2 groups were compared. The endoscopic screening, pathological diagnosis and treatment of esophageal cancer and precancerous lesions in 2005-2009 years were carried out in two patients. The time interval between the two endoscopic intervals was calculated, and the endoscopic diagnostic results were compared before and after two times. The cumulative progression rate and cumulative progress probability of precancerous lesions at various levels were calculated annually, and the cumulative progress probability of gender and age was compared. Collect the death incidence and population screening cover end point outcome data using the trend, calculated by x2 test every year, different levels of pathologic diagnosis, the cumulative incidence of mortality; x2 test comparing the level of pathological diagnosis study in different gender and age between the incidence rate and death rate difference; for mild dysplasia in 3 year cumulative incidence compared with other year cumulative incidence of moderate dysplasia; 1 year cumulative incidence compared with other year cumulative incidence. Results of the study, 1. subjects covered 99060 people, of which 46568 were 40-69 years old, and 21955 were screened for the first time in endoscopic screening and 47.15% for endoscopic screening. The compliance of women (50.91%, 11739/23058) was higher than that of men (43.45%, 10216/23510) (x2=47.15, P0.001). The removal of biopsy tissue was not enough to diagnose 191 people, and a total of 21764 people were included in this study. The detection rate of esophageal lesions was 24.65% (5365/21764). Basal cell hyperplasia was seen in 1729 cases (7.94%, 95% CI:7.59%-8.30%), low grade intraepithelial neoplasia in 3163 cases (14.53%, 95%CI:14.06%-15.00%), high-grade intraepithelial neoplasia in 335 cases (1.54%, 95%CI:1.38%-1.70%), and esophageal cancer in 138 cases (0.63%, 95%CI:0.53%-0.74%). The rate of detection is from high to low in the following order: low grade intraepithelial neoplasia and high grade intraepithelial neoplasia of esophagus. In the esophageal cancer and the precancerous lesions at all levels, the male detection rate was significantly higher than that of the female. Basal cell hyperplasia of male and female detection rates were 9.05% and 6.98% (x2=19.438, P0.001); low level. Male and female detection rates were 15.85% and 13.38% intraepithelial neoplasia (x2=26.661, P0.001); high grade intraepithelial neoplasia _ male and female detection rates were 1.74% and 1.37% (x2=4.865, P=0.027) esophageal cancer; male and female detection rates were 0.85% and 0.45% (x2=13.829, P0.001). The detection rates of basal cell proliferation, low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia and esophageal cancer all increased with age. The trend of x2 test was statistically significant. At the age of 40~44, the detection rate of precancerous lesions at all levels was the lowest, which were 7.61% (425/5585), 6.70% (374/5585), 0.34% (19/5585) and 0.18% (10/5585) respectively, and 65-69 years old subjects were 8.14% (84/1093), 21.87% (239/1093), 3.84% (42/1093) and 1.92% (21/1093), respectively. And in each age group, the detection rate was from high to low to low grade intraepithelial neoplasia and high grade of intraepithelial neoplasia. Linzhou, Cixian, Feicheng and three levels of esophageal precancerous lesion detection rate were different, the difference was statistically significant; the basal cell hyperplasia detection rate of Cixian is the highest, was 18.57% (1136/6116). Low grade intraepithelial neoplasia and high grade intraepithelial neoplasia detection rate was highest in Linzhou, were 17.40% (1787/10269) and 1.80% (185/10269). There was no significant difference in the detection rate of three esophageal carcinoma (Z2=0.613, P=0.736). A total of 21955 people screened for endoscopy in 2.2005-2009 were enrolled in the past 9 years. 2389 patients were followed up for 9 years. The adherence of endoscopic screening was 10.88%, of which 11.26% of male endoscopy screening and 10.55% of female endoscopic screening were not statistically significant (x2=0.096, P=0.099). Three esophageal cancer early diagnosis and treatment demonstration base two endoscopic screening compliance is relatively low, of which Linzhou two endoscopic screening compliance is the highest, 15.81%, Cixian two endoscopic screening compliance is the lowest, only 4.5%. In the first seven years of follow-up, the cumulative progression rate of moderate atypical hyperplasia was always higher than that of mild atypical hyperplasia; after seventh years of follow-up, the cumulative rate of progress of the two was cross. For mild dysplasia, 2-4 year cumulative progress rate from 0.18% in 1.07%, the cumulative progress rate is low, and the change is not obvious, to the fifth year and later progress rate, average growth of more than 1 percentage points; for moderate dysplasia, 2-4 year cumulative progress rate is higher, but the change rate is 3.33%-3.59%, little 4-5 by the 3.59% progress is 4.62%; for low grade intraepithelial neoplasia, also have similar mild dysplasia and moderate dysplasia of the law. Male moderate atypical hyperplasia followed up for 2-9 years. The cumulative progression rate (5.29%-10.58%) was always higher than that of mild atypical hyperplasia (0.18%-7.18%). The cumulative progression rate of female moderate atypical 2-4 years was higher than that of mild atypical hyperplasia, and 5 years later, it was lower than mild atypical hyperplasia. In all age groups, the cumulative progression rate of moderate atypical hyperplasia was significant at the beginning of the follow-up.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R735.1

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