| 刘付东,田 庆,吴玲玲,等.2013—2017年江苏省盐城市盐都区淮河流域上消化道癌早诊早治项目效果评价[J].中国肿瘤,2026,35(10):771-776. |
| 2013—2017年江苏省盐城市盐都区淮河流域上消化道癌早诊早治项目效果评价 |
| Effectiveness of the Huaihe River Basin Upper Gastrointestinal Cancer Early Diagnosis and Treatment Project in Yandu District， Yancheng City from 2013 to 2017 |
| 投稿时间：2026-05-11 |
| DOI：10.11735/j.issn.1004-0242.2026.10.A004 |
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| 中文关键词: 上消化道癌 早诊早治 发病 死亡 成本效果分析 江苏 |
| 英文关键词:upper gastrointestinal cancer early diagnosis and treatment incidence mortality cost-effectiveness Jiangsu |
| 基金项目:江苏省疾病预防控制局科技计划项目（JSJK2026D00038）;盐城市卫健委医学科研立项项目（YK2025153） |
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| 中文摘要: |
| 摘 要：［目的］ 分析盐城市盐都区淮河流域上消化道癌早诊早治项目筛查效果，评估项目对盐都区恶性肿瘤发病和死亡风险的影响。［方法］ 采用整群抽样的方法，收集2013—2017年盐都区参加淮河流域上消化道癌早诊早治项目数据和2013—2020年盐都区肿瘤登记系统中恶性肿瘤的发病和死亡数据。将参与筛查人群作为筛查组，未能参与项目的人群作为未筛查组，比较筛查组和未筛查组上消化道癌高危人群阳性病例的检出情况，以及上消化道癌的发病率和死亡率。采用相对危险度（relative rate，RR）及其95%置信区间（confidence interval，CI）评估筛查项目对盐都区发病和死亡风险的影响，分析筛查项目的经济学效益。［结果］ 2013—2017年共47 717人纳入队列，其中筛查组13 335人，未筛查组34 382人。上消化道阳性病例共73例，检出率为0.54%，其中食管、胃部阳性检出率分别为0.25%和0.29%。筛查组上消化道癌发病密度（273.04/10万人年）和死亡密度（100.86/10万人年）均高于未筛查组（发病密度为158.12/10万人年，死亡密度为73.08/10万人年）。筛查组食管癌的发病风险较非筛查组高72%（RR=1.72，95%CI：1.37~2.14，P＜0.05），胃癌的发病风险高73%（RR=1.73，95%CI：1.43~2.08，P＜0.05）。筛查组食管癌死亡风险较非筛查组高28%（RR=1.28，95%CI：0.89~1.79，P=0.162），但是差异没有统计学意义，胃癌死亡风险高48%（RR=1.48，95%CI：1.06~2.02，P＜0.05）。成本效果分析结果显示，项目的成本效果比为11.11万元，发现早期病例的平均费用为17.39万元，早期发现成本系数为2.50。［结论］ 盐都区淮河流域上消化道癌早诊早治项目具有良好的成本效用价值，筛查组恶性肿瘤的发病密度、死亡密度、发病风险和死亡风险均高于未筛查组，提示筛查工作可发现更多的患者，有助于上消化道癌的早期发现，从而降低人群的发病率和死亡率。 |
| 英文摘要: |
| Abstract： ［Purpose］ To evaluate the effectiveness of the Huaihe River Basin Upper Gastrointestinal Cancer Early Diagnosis and Treatment Project in Yandu District， Yancheng City of Jiangsu Province and to assess its impact on cancer incidence and mortality in the local population. ［Methods］ Using cluster sampling， we collected data from participants of the screening project in Yandu District from 2013 to 2017， along with cancer incidence and mortality records from the Yandu Cancer Registry (2013—2020). The screening group comprised those who underwent endoscopic examination after high-risk assessment； the unscreened group included those who did not participate. We compared the detection rates of positive lesions， as well as incidence and mortality rates of upper gastrointestinal (UGI) cancer between the two groups. Relative risk (RR) and its 95% confidence interval(CI） were calculated to evaluate the impact of the screening project on incidence and mortality. Cost-effectiveness analysis was also performed. ［Results］ A total of 47 717 individuals were enrolled in the cohort (13 335 in the screening group， 34 382 in the unscreened group). Overall， 73 positive cases of UGI were detected， with a detection rate of 0.54% (esophageal： 0.25%， gastric： 0.29%). The screening group had a higher incidence density (273.04/105 person-years) and mortality density (100.86/105 person-years) for UGI cancer compared with the unscreened group (158.12/105person-years and 73.08/105 person-years， respectively). Relative risk analysis showed that the screening group had a 72% higher risk of esophageal cancer (RR=1.72， 95%CI： 1.37-2.14， P<0.05) and a 73% higher risk of gastric cancer (RR=1.73， 95%CI： 1.43-2.08， P<0.05). For mortality， the screening group had a 48% higher risk of gastric cancer death (RR=1.48， 95%CI： 1.06-2.02， P<0.05). The risk of esophageal cancer mortality was also elevated in the screening group(RR=1.28， 95%CI： 0.89-1.79)， but the difference was not statistically significant (P=0.162). Cost-effectiveness analysis showed that the cost-effectiveness ratio was 111 100 yuan per case detected， the average cost per early case detected was 173 900 yuan， and the early detection cost coefficient was 2.50. ［Conclusion］ The screening project in Yandu District demonstrates favorable cost-effectiveness. The higher incidence and mortality densities， as well as the elevated relative risks observed in the screening group， suggest that screening may facilitate earlier detection of UGI cancer and help reduce population-based incidence and mortality in the long run. |
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