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2014—2021年徐州市城市居民结直肠癌筛查和随访分析

Colorectal cancer in urban residents of Xuzhou from 2014 to 2021: a screening and follow-up study

    摘要
  • 摘要:
    目的 分析2014―2021年江苏省徐州市城市居民结直肠癌（CRC）筛查和随访结果，为当地结直肠癌筛查策略的优化提供参考依据。
    方法 于2014年7月—2021年12月，采用随机整群抽样方法，抽取徐州市鼓楼区8个社区、云龙区5个社区、泉山区15个社区、贾汪区5个社区和铜山区11个社区共44个社区的521 799名40～74岁城市居民进行风险评估问卷调查。评估出结直肠癌的高危人群进行结直肠癌临床筛查。分析该地区城市居民结直肠癌的高危率、结肠镜检查依从率和病变检出率，并对所有参与风险评估问卷调查者进行定期随访，详细记录随访结局。
    结果 2014—2021年，徐州市共完成118 012名城市居民的问卷评估，评估出结直肠癌高危人群15 444人，高危率为13.09%；评估的结直肠癌高危人群中接受肠镜检查者4 070人，肠镜检查依从率为26.35%；结肠镜检查者中检出非瘤性息肉1 096例、非进展期腺瘤812例、进展期腺瘤191例和结直肠癌5例，检出率分别为26.93%、19.95%、4.69%和0.12%，早诊率为85.46%（194/227）。截至2023年12月31日，中位随访时间为6.1年，共报告结直肠癌发病458例，累积发病率为0.39%；报告结直肠癌死亡107例，累积死亡率为0.09%；经病理确诊有明确肿瘤分期（TNM）的共280例，占全部新发结直肠癌病例的61.14%；高危组早期癌比例（62.79%）高于非高危组早期癌比例（44.73%），差异有统计学意义（χ2=4.76，P=0.029）。
    结论 2014—2021年徐州市城市居民结直肠癌高危人群肠镜检查依从率和结直肠癌检出率均较低；高危组早期癌比例高于非高危组，在高危人群中进行结直肠癌筛查可以提高早诊率。

     

    Abstract:
    Objective To analyze the screening and follow-up results for colorectal cancer (CRC) among urban residents in Xuzhou city, Jiangsu province from 2014 to 2021, thereby providing evidence for optimizing local CRC screening strategies.
    Methods From July 2014 to December 2021, a randomized cluster sampling method was used to select 521 799 urban residents aged 40–74 years from 44 communities (8 in Gulou district, 5 in Yunlong district, 15 in Quanshan district, 5 in Jiawang district, and 11 in Tongshan district) in Xuzhou city. A risk assessment questionnaire was administered to identify high-risk populations for CRC, followed by clinical screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were analyzed. All participants in the questionnaire survey underwent regular follow-up, with detailed documentation of outcomes.
    Results From 2014 to 2021, a total of 118 012 urban residents in Xuzhou completed the questionnaire, with 15 444 high-risk individuals (high-risk rate: 13.09%) being identified. Among the high-risk group, 4 070 underwent colonoscopy (compliance rate: 26.35%). Colonoscopy detected non-neoplastic polyps (1 096 cases), non-advanced adenomas (812 cases), advanced adenomas (191 cases), and CRC (5 cases), which showed the detection rates of 26.93%, 19.95%, 4.69%, and 0.12%, respectively. The early diagnosis rate was 85.46% (194/227). By December 31, 2023, the median follow-up time was 6.1 years, with 458 reported CRC cases (cumulative incidence: 0.39%) and 107 CRC deaths (cumulative mortality: 0.09%). Among confirmed cases with TNM staging (280 cases, 61.14% of total new cases), the proportion of early-stage cancer was higher in the high-risk group (62.79%) than in the non-high-risk group (44.73%) (χ2 = 4.76, P = 0.029).
    Conclusions From 2014 to 2021 in Xuzhou, colonoscopy compliance and CRC detection rates remained low among high-risk urban populations. The high-risk group exhibited a higher proportion of early-stage cancer than the non-high-risk group, which suggested that CRC screening in high-risk populations can improve the early diagnosis rate.

     

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