| 王心怡,刘儒月,于 航,等.诊疗时效性对上消化道癌筛查阳性者10年生存率的影响分析[J].肿瘤学杂志,2026,32(4):282-289. |
| 诊疗时效性对上消化道癌筛查阳性者10年生存率的影响分析 |
| Effect of Timeliness of Diagnosis and Treatment on the 10-Year Survival Among Screening-Positive Patients with Upper Gastrointestinal Cancer |
| 投稿时间：2025-09-23 |
| DOI：10.11735/j.issn.1671-170X.2026.04.B003 |
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| 中文关键词: 上消化道癌 诊疗时效性 筛查阳性 早诊早治 及时诊疗 |
| 英文关键词:upper gastrointestinal cancer timeliness of diagnosis and treatment screening-positive early diagnosis and treatment timely diagnosis and treatment |
| 基金项目:学科集群创新工程（TS001） |
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| 摘要点击次数: 12 |
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| 中文摘要: |
| 摘 要：［目的］ 分析诊疗时效对上消化道癌筛查阳性者生存结局的影响，并探讨“筛查-治疗”的最优时间间隔。［方法］ 研究基于山东省肥城市上消化道癌人群筛查队列，纳入2014年1月至2015年12月参加内镜筛查且被确诊为筛查阳性的患者（包括高级别上皮内瘤变和早期癌）作为研究对象，通过匹配肿瘤发病登记库和死因登记库获得筛查阳性者的10年生存率信息。根据筛查阳性者从筛查到开始诊疗的间隔时间，以30 d为界，将患者分为及时诊疗组（≤30 d）、延迟诊疗组（＞30 d）。采用Kaplan-Meier法计算筛查阳性者的10年生存率，多因素 Cox 比例风险回归模型评估诊疗时效性与死亡风险之间的关系。 ［结果］ 共纳入267例筛查阳性者，平均年龄为（70.7±6.1）岁，全组总体10年生存率为79.6% ［95%置信区间（confidence interval，CI）：74.8%~84.6%］，其中及时诊疗组的10年生存率达94.4%（95%CI：89.2%~99.9%），显著高于延迟诊疗组的74.1% （95%CI：68.1%~80.5%）。将延迟诊疗（＞30 d）时间进一步细分为60 d内、90 d内和超过90 d，发现随着诊疗时间的延长，上消化道癌筛查阳性者的生存率呈现明显下降趋势。多因素分析显示，年龄较高（＞75岁）、体质指数＞24 kg/m2及治疗方式为手术/其他的筛查阳性者更容易发生延迟诊疗行为（P均＜0.05）。［结论］及时诊疗对改善筛查阳性者的预后具有关键意义。应加强对筛查阳性者的全流程管理，构建“早筛-早治”的闭环管理体系，从而最大限度提升筛查阳性者的长期生存率和健康获益，同时实现医疗资源的高效利用。 |
| 英文摘要: |
| Abstract： ［Objective］ To analyze the impact of timeliness of diagnosis and treatment on the survival outcomes among screening-positive patients with upper gastrointestinal cancer， and to explore the optimal interval between screening and treatment. ［Methods］ The study data were obtained from a population-based upper gastrointestinal cancer screening cohort in Feicheng City， Shandong Province. Patients who underwent endoscopic screening between January 2014 and December 2015 and were identified as screening positive (high grade intraepithelial neoplasia or early stage cancer) were included. Ten-year survival data were obtained through linkage with the cancer registry and death registry. Based on the interval from screening positivity to treatment initiation， patients were classified into the timely treatment group(≤30 d) and the delayed treatment group (>30 d). The Kaplan-Meier method was used to calculate the 10 year survival rate， and a multivariate Cox proportional hazards regression model was applied to evaluate the association between timeliness of diagnosis and treatment and the risk of death. ［Results］ A total of 267 screening positive patients were included， with a mean age of (70.7±6.1) years old. The overall 10-year survival rate was 79.6% ［95% confidence interval(CI)： 74.8%~84.6%］. The timely treatment group had a 10-year survival rate of 94.4% (95%CI： 89.2%~99.9%)， which was significantly higher than that of the delayed treatment group (74.1%， 95%CI： 68.1%~80.5%). When the delayed treatment interval was further categorized into ≤60 d， ≤90 d， and >90 d， a clear decreasing trend in survival was observed with longer delays. Multivariate analysis showed that older age (>75 years old)， body mass index(BMI)>24 kg/m2， and receiving surgery/other treatment were independently associated with delayed diagnosis and treatment(all P<0.05). ［Conclusion］ Timely diagnosis and treatment are critical for improving the prognosis of screening positive patients with upper gastrointestinal cancer. Strengthening the integrated management of the entire screening to treatment pathway and establishing a closed loop “early screening-early treatment” system could maximize long term survival and health benefits for these patients， while promoting efficient use of medical resources. |
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