Screening, early diagnosis and treatment of liver cancer in Zherong county of Fujian province: 2012 – 2019
-
摘要:
目的 分析福建省肝癌筛查及早诊早治结果,为肝癌人群筛查效果评价提供科学基础资料。方法以福建省柘荣县为肝癌筛查现场,采用整群抽样的方法选取35~64岁男性居民和45~64岁女性居民作为研究对象。采用血清乙肝表面抗原(HBsAg)作初筛(诊断性筛查);对HBsAg阳性者每6个月联合应用血清甲胎蛋白(AFP)和肝脏B超随访复查。评估指标为任务完成率、检出率、早诊率和治疗率。对所有检出的肝癌患者开展随访,随访截止到2021年4月30日,采用寿命表法计算观察生存率。 结果 2012年7月 — 2020年12月共完成诊断性筛查51486人,HBsAg阳性4412例,阳性率8.72 %;阳性队列人群每6个月的随访完成10653人次;总体任务完成率为94.16 %。共检出49例肝癌病例,检出率0.32 %,早诊率40.81 %,治疗率79.59 %。筛查队列肝癌患者的1、3、5年生存率分别为75.51 %、43.28 %和34.96 %;2012 — 2014年福建省肿瘤登记地区肝癌患者则分别为36.18 %、16.56 %和11.60 %,两组患者生存率差异均有统计学意义(均P < 0.05)。 结论 采用AFP联合超声的筛查方法,能检出更多肝癌患者,发现更多早期患者,提高患者生存率。应加强随访人群的依从性,提高肝癌筛查的效果。 Abstract:Objective To examine outcomes of screening, early diagnosis and treatment of liver cancer in Fujian province and to provide evidences for the evaluation on population-based liver cancer screening. Methods Zherong county in a mountainous rural region of the province was selected with cluster sampling for the analysis. Serum hepatitis B virus surface antigen (HBsAg) was tested among all male residents aged 35 – 64 years and female residents aged 45 – 64 years in diagnostic screenings on liver cancer carried out from July 2012. Then serum alpha-fetoprotein (AFP) detection and B-mode ultrasonography (BU) of liver were performed in all HBsAg-positive residents every 6 months after the screening. All diagnosed liver cancer patients were followed up till April 30th, 2021 and observed survival of the patients were calculated with life table method. The efficiency of the screening, early diagnosis and treatment were assessed using rate of task completion, detection, early diagnosis, and early treatment. Results Of 51 486 residents having HBsAg screening from July 2012 through December 2019, 4 412 (8.72%) were positive. Among the HBsAg-positive participants, 10 653 person-times of AFP detection and BU of liver were carried out, with an overall task completion rate of 94.16%, and totally 49 liver cancer cases were detected, with the detection rate of 0.32%. For all the diagnosed liver cancer cases, the rate of early detection was 40.81% and that of early treatment was 79.59%. The calculated 1-, 3-, 5-year survival of the liver cancer cases were 75.51%, 43.28%, and 34.96% and the survivals were significantly higher than those of 36.18%, 16.56%, and 11.60% for the liver cancer patients registered from 2012 through 2014 in Fujian Provincial Cancer Registry System (P < 0.05 for all). Conclusion The study findings suggest that semiannual serum AFP detection and BU of liver could detect liver cancer cases more effectively in HBsAg-positive population and the survival of the detected liver cases may be increased due to early diagnosis and treatment. -
Key words:
- liver cancer /
- screening /
- early diagnosis and treatment
-
表 1 2012 — 2019年柘荣县肝癌筛查及早诊早治筛查结果
年度 a 任务数
(人次数)完成数
(人次数)完成率
(%)首次诊断性筛查 随访筛查 初筛数 HBsAg
阳性数病例数 早期
病例数治疗
例数随访
人次数1年2次
随访比例(%)病例数 早期
病例数治疗例数 2012 2 000 1526 76.30 9876 841 1 1 1 685 2 1 1 2013 2 000 1620 81.00 11757 1011 2 1 2 609 0.00 2 1 1 2014 2 000 2017 100.85 7092 545 1 0 1 1472 68.89 3 3 2 2015 2 000 2142 107.10 6118 507 1 0 0 1635 65.20 7 1 5 2016 2 000 1 871 93.55 4129 332 1 1 1 1539 69.79 1 1 1 2017 2 000 2 006 100.30 4900 453 1 0 1 1553 70.96 7 2 6 2018 2 000 2 023 101.15 4780 450 1 0 1 1573 56.33 10 4 8 2019 2 000 1 860 93.00 2834 273 0 0 0 1587 81.03 9 4 8 合计 16000 15065 94.16 51486 4412 8 3 7 10653 60.33 41 17 32 注:a 年度为非自然年,时间为当年7月至次年6月。受新冠肺炎疫情影响,2019年度推迟至2020年12月。 -
[1] 国家癌症中心. 2019中国肿瘤登记年报[M]. 北京: 人民卫生出版社, 2021: 75 – 77. [2] 左婷婷, 郑荣寿, 曾红梅, 等. 中国肝癌发病状况与趋势分析[J]. 中华肿瘤杂志, 2015, 37(9): 691 – 696. doi: 10.3760/cma.j.issn.0253-3766.2015.09.013 [3] 安澜, 曾红梅, 郑荣寿, 等. 2015年中国肝癌流行情况分析[J]. 中华肿瘤杂志, 2019, 41(10): 721 – 727. [4] 陈传本. 2019福建省肿瘤登记年报[M]. 福州: 福建科学技术出版社, 2020: 23 – 25. [5] 林永添, 马晶昱, 相智声, 等. 2017年福建省肿瘤登记地区肝癌发病和死亡分析[J]. 中国癌症防治杂志, 2021, 13(2): 159 – 163. doi: 10.3969/j.issn.1674-5671.2021.02.09 [6] 卫生部疾病预防控制局, 癌症早诊早治项目专家委员会. 癌症早诊早治项目技术方案(2011年版)[M]. 北京: 人民卫生出版社, 2011: 1 – 144. [7] Hassan MM, Hwang LY, Hatten CJ, et a1. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus[J]. Hepatology, 2002, 36(5): 1206 – 1213. doi: 10.1053/jhep.2002.36780 [8] 陈建国, 陆建华, 朱源荣, 等. 乙型肝炎病毒感染与肝癌发生的31年随访研究[J]. 中华流行病学杂志, 2010, 31(7): 721 – 726. [9] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 中国实用外科杂志, 2020, 40(2): 121 – 138. [10] 白方舟, 刘成成, 王宇婷, 等. 我国肝癌患者年例均费用的全病程视角分析[J]. 中华健康管理学杂志, 2019, 13(5): 387 – 393. doi: 10.3760/cma.j.issn.1674-0815.2019.05.003 [11] 陈建国, 张永辉, 朱健, 等. 启东肝癌的早诊早治及筛查效果评价[J]. 中华肿瘤杂志, 2017, 39(12): 946 – 951. doi: 10.3760/cma.j.issn.0253-3766.2017.12.013 [12] 俞霞, 程伟民, 吴标华, 等. 中山市小榄镇肝癌高危人群筛查依从性及筛查效果分析[J]. 中国肿瘤临床, 2020, 47(7): 350 – 353. doi: 10.3969/j.issn.1000-8179.2020.07.111 [13] 钱俊华, 罗鹏飞, 陈燕熙, 等. 海门市肝癌早诊早治的主要经验与成效分析[J]. 江苏预防医学, 2019, 30(6): 697 – 698,704. [14] 顾安信, 黄锦义, 刘玉萍, 等. 广西武鸣壮族地区肝癌高发人群筛查和早诊早治研究[J]. 医药前沿, 2019, 9(16): 232 – 234. [15] Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2019[J]. CA:A Cancer Journal for Clinicians, 2019, 69(5): 363 – 385. doi: 10.3322/caac.21565 [16] Zeng HM, Chen WQ, Zheng RS, et al. Changing cancer survival in China during 2003 – 15: a pooled analysis of 17 population - based cancer registries[J]. The Lancet Global Health, 2018, 6(5): e555 – e567. doi: 10.1016/S2214-109X(18)30127-X [17] Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma[J]. Journal of Cancer Research and Clinical Oncology, 2004, 130(7): 417 – 422. [18] 陈燕熙, 倪倬健. 1968年 – 2009年海门市居民肝癌死亡率变化趋势[J]. 肿瘤预防与治疗, 2011, 24(4): 150 – 153. [19] Ji MF, Liu ZW, Chang ET, et al. Mass screening for liver cancer: results from a demonstration screening project in Zhongshan city, China[J]. Scientific Reports, 2018, 8(1): 12787. doi: 10.1038/s41598-018-31119-9 [20] Yeh YP, Hu TH, Cho PY, et al. Evaluation of abdominal ultrasonography mass screening for hepatocellular carcinoma in Taiwan[J]. Hepatology, 2014, 59(5): 1840 – 1849. doi: 10.1002/hep.26703 [21] 曹毛毛, 陈万青. 肝癌筛查研究进展[J]. 中国肿瘤, 2020, 29(12): 925 – 932. doi: 10.11735/j.issn.1004-0242.2020.12.A007