| 田忠剑,沈 欢,孙中明,等.2013—2023年江苏省淮安市食管癌高危人群内镜筛查参与率影响因素分析及预测列线图构建[J].中国肿瘤,2026,35(10):761-770. |
| 2013—2023年江苏省淮安市食管癌高危人群内镜筛查参与率影响因素分析及预测列线图构建 |
| Factors Influencing Endoscopic Screening Participation and the Development of a Nomogram Prediction Model Among High-Risk Populations for Esophageal Cancer in Huai’an City from 2013 to 2023 |
| 投稿时间：2026-05-13 |
| DOI：10.11735/j.issn.1004-0242.2026.10.A003 |
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| 中文关键词: 食管癌 内镜筛查 早诊早治 列线图 淮河流域 江苏 |
| 英文关键词:esophageal cancer endoscopic screening early diagnosis and early treatment nomogram Huaihe River Basin Jiangsu |
| 基金项目:江苏省第五期“333工程”科研资助立项项目（BRA2017242）；江苏省预防医学科研课题项目（Ym2023086）；淮安市自然科学研究计划（联合专项）卫生健康类项目（HABL202265） |
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| 中文摘要: |
| 摘 要：［目的］ 分析淮安市食管癌高危人群内镜筛查参与率的影响因素，构建并验证筛查参与意愿的预测列线图模型，为提升高危人群筛查参与率提供依据。［方法］ 回顾性分析2013—2023年淮安市淮河流域食管癌早诊早治项目57 368名40~69岁居民的筛查数据，通过单因素分析和多因素Logistic回归筛选内镜筛查参与的影响因素。按7∶3比例随机分为训练集（14 633人）与验证集（6 270人）构建列线图预测模型，分别通过受试者工作特征曲线下面积（area under curve，AUC）及其95%置信区间（confidence interval，CI）、校准曲线、Hosmer-Lemeshow检验与临床决策曲线分析（decision curve analysis，DCA）验证其预测效能。［结果］ 2013—2023年共完成57 368名目标人群的健康因素调查，累计评估出食管癌高危对象20 903人，总体高危率为36.44%，高危人群中共8 570人完成内镜筛查，总体内镜筛查参与率为41.00%。多因素Logistic回归分析结果显示，40~49岁、女性、饮用非自来水、家庭年收入＜3万元、大专及以上教育程度、不吸烟以及有肿瘤家族史的高危人群更愿意参与内镜筛查，而50~59岁及60~69岁年龄组、超重、肥胖以及无肿瘤家族史人群的内镜检查参与率较低。基于上述影响因素构建食管癌高危人群内镜筛查参与率列线图模型，列线图模型训练集AUC为0.675（95%CI：0.666~0.684），验证集AUC为0.682（95%CI：0.668~0.695）；训练集Hosmer-Lemeshow拟合优度检验结果为χ2=3.217，P=0.920，验证集Hosmer-Lemeshow拟合优度检验为χ2=12.936，P=0.114，提示预测模型拟合优度较好。DCA曲线证实模型具备良好临床净获益。［结论］ 淮安市食管癌高危率偏高，后续应通过强化健康教育、普及癌症防治知识、倡导健康生活方式等健康促进措施改善这一状况。本研究构建的列线图模型具有良好的区分度与校准度，可用于食管癌高危人群内镜筛查参与意愿的分层评估，为干预措施的制定提供科学依据。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze factors influencing endoscopic screening participation among high-risk populations for esophageal cancer in Huai’an City， and to construct and validate a nomogram for predicting screening willingness. ［Methods］ A retrospective analysis was conducted on screening data from 57 368 residents aged 40-69 years old who participated in the Huaihe River Basin Esophageal Cancer Early Diagnosis and Treatment Project in Huai’an City from 2013 to 2023. A total of 20 903 high-risk individuals were identified through health risk factor questionnaires. Univariate analysis and multivariate Logistic regression were used to identify factors associated with endoscopic screening participation. The dataset was randomly split into a training set(n=14 633) and a validation set(n=6 270) at a 7∶3 ratio. A nomogram was constructed and evaluated using the area under the receiver operating characteristic curve (AUC) and its 95% confidence interval(CI )， calibration curves， the Hosmer-Lemeshow test， and decision curve analysis (DCA). ［Results］ The overall high-risk rate was 36.44% (20 903/57 368). Among the high-risk individuals， 8 570 (41.00%) underwent endoscopic screening. Multivariate Logistic regression showed that factors associated with higher participation included age 40-49 years old， female， non-tap water sources， annual household income < 30 000 yuan， college education or above， non-smoking， and a family history of cancer. Conversely， aged 50-59 and 60-69 years old， overweight/obesity， and no family history of cancer were associated with lower participation. The nomogram achieved AUCs of 0.675 (95%CI： 0.666-0.684) in the training set and 0.682 (95%CI： 0.668-0.695) in the validation set. The Hosmer-Lemeshow test yielded χ2=3.217 (P=0.920) for the training set and χ2=12.936 (P=0.114) for the validation set， indicating good calibration. DCA confirmed favorable net clinical benefit. ［Conclusion］ The high-risk rate of esophageal cancer in Huai’an City is relatively high， necessitating health promotion interventions such as enhanced education， cancer prevention awareness， and healthy lifestyle advocacy. The nomogram demonstrates adequate discrimination and calibration， and may serve as a useful tool for stratified assessment of screening willingness， supporting the development of targeted intervention strategies. |
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