| 路 明,王世乐,钟培松,等.上海市嘉定区肝癌重点人群筛查结果分析[J].肿瘤学杂志,2026,32(7):547-552. |
| 上海市嘉定区肝癌重点人群筛查结果分析 |
| Screening Outcomes for Liver Cancer Among Key Populations in Jiading District of Shanghai |
| 投稿时间：2026-06-02 |
| DOI：10.11735/j.issn.1671-170X.2026.07.B004 |
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| 中文关键词: 肝肿瘤 肿瘤筛查 甲胎蛋白 PIVKA-Ⅱ GAAD评分 上海 |
| 英文关键词:liver neoplasms cancer screening alpha-fetoprotein PIVKA-Ⅱ GAAD score Shanghai |
| 基金项目:复旦大学公共卫生学院-嘉定区卫生健康委公共卫生高质量发展重点专项（GWGZLXK-2023-01） |
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| 中文摘要: |
| 摘 要：［目的］ 分析上海市嘉定区肝癌重点人群肝癌筛查结果，为完善重点人群筛查策略提供科学依据。［方法］ 通过整合上海市嘉定区卫生信息平台（含医疗机构诊疗记录）、中国疾病预防控制信息系统（含传染病报告卡、死亡监测数据）及国家肿瘤登记系统等多源数据，筛选符合肝癌高危因素的重点人群，采用“超声+甲胎蛋白+PIVKA-Ⅱ+GAAD评分”进行肝癌筛查，将筛查阳性者转至定点医院进一步诊断和治疗。采用χ2检验、多因素Logistic回归分析筛查阳性的相关因素。［结果］ 通过多源数据筛选符合肝癌高危因素的重点人群12 013人，采用“超声+甲胎蛋白+PIVKA-Ⅱ+GAAD评分”获得筛查阳性1 230例，检出率为10.24%（1 230/12 013）。多因素Logistic回归分析显示，男性、≥60岁和有肝硬化病史者筛查阳性率更高。随访至2025年8月，确诊肝癌16例，检出率为0.13%（16/12 013）；其中早期病例12例。筛查阳性中男性、有肝硬化、乙肝或脂肪肝病史者确诊肝癌的比例更高。［结论］ 信息化数据筛选可简化肝癌重点人群筛查流程，“超声+甲胎蛋白+PIVKA-Ⅱ+GAAD评分”的筛查组合可以提升早期肝癌检出率。肝癌重点人群中男性、≥60岁和有肝硬化病史者是最优先入组人群，筛查阳性人群中男性、有肝硬化、乙肝或脂肪肝病史人群是干预重点人群。 |
| 英文摘要: |
| Abstract： ［Objective］ To analyze the results of liver cancer screening among key populations in Jiading District of Shanghai， so as to provide scientific evidence for improving screening strategies for high-risk groups. ［Methods］ Key populations at high-risk of liver cancer were identified through the integration of multiple data sources， including the Jiading District Health Information Platform (containing medical records)， the China Information System for Disease Control and Prevention (containing notifiable disease reports and mortality surveillance data)， and the National Cancer Registration System. Primary screening was performed using a combined panel consisting of ultrasound， alpha-fetoprotein (AFP)， protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)， and the GAAD score. Participants with positive screening results were referred to designated hospitals for further diagnosis and treatment. The chi-square test and multivariate Logistic regression were used to identify factors associated with positive primary screening results. ［Results］ A total of 12 013 individuals meeting the predefined high-risk criteria were enrolled. Primary screening with combined panel consisting of ultrasound， AFP， PIVKA-Ⅱ and the GAAD score identified 1 230 positive cases， yielding a positivity rate of 10.24% (1 230/12 013). Multivariate Logistic regression showed that male， age≥60 years old， and a history of cirrhosis were independently associated with a higher positivity rate. By the follow-up in August 2025， 16 liver cancer cases were confirmed， with a detection rate of 0.13%(16/12 013)， 12 cases were diagnosed at early stages. Among screen-positive individuals， males， and those with a history of cirrhosis， hepatitis B， or fatty liver disease had a significantly higher proportion of confirmed liver cancer. ［Conclusion］ Information-system-based screening can streamline the enrollment process for key populations. The combined screening panel of ultrasound， AFP， PIVKA-Ⅱ， and GAAD score may significantly improve the detection rate of early-stage liver cancer. Males， individuals aged ≥60 years old， and those with a history of cirrhosis should be prioritized for enrollment. Among screen-positive participants， males， and those with a history of cirrhosis， hepatitis B， or fatty liver disease represent key subgroups for focused intervention. |
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