摘要
背景:在我国有无必要开展大肠癌普查仍存在一定争议。目的:比较、分析医院就诊人群与普查人群中大肠癌患者临床资料的异同,探讨普查在大肠癌早期诊断中的作用。方法:就诊组:由协作组各成员医院按统一设计的调查表,前瞻性地登记2002年4月1日～2003年3月31日到医院就诊,并接受结肠镜检查的大肠癌患者的全部临床资料。普查组:采用“序贯粪便隐血筛检技术”,于2001年3～6月对北京地区约2万名35岁以上的自然人群进行大肠癌普查。两组大肠癌患者的诊断均经术后病理检查证实。结果:就诊组和普查组患者中,≥50岁者分别占81.9%和83.3%。就诊组DukesA、B期患者占41.1%,普查组占91.7%(P<0.001)。普查人群中存在大肠癌高危因素者的大肠癌检出率为0.28%,无高危因素者的检出率为0.05%(P<0.001)。就诊组中,内镜表现为隆起型病变者44.7%是DukesA、B期患者,溃疡型病变者仅10.0%是DukesA、B期患者(P<0.001);DukesA、B期患者的粪便隐血试验阳性率为78.5%,C、D期患者为81.9%(P>0.05),提示粪便隐血试验阳性率与大肠癌分期无关;DukesC、D期患者的血清CEA阳性率显著高于A、B期患者(P=0.019);高、中分化癌中DukesA、B期患者占51.8%,低分化癌中DukesA、B期患者仅占26.5%(P<0.001)。
Background: There is controversy on the significance of mass screening of colorectal cancer (CRC) in China. Aims: To compare and analyze the clinical data of patients with CRC either clinically diagnosed in hospitals or detected by mass screening, and to evaluate the beneficial effect of mass screening on early detection of CRC. Methods: In the clinically diagnosed group, based on a given program, all the clinical data of CRC patients undergoing colonoscopy were collected prospectively from hospitals of the cohort study group, dating from April 1, 2002 to March 31, 2003. In mass screening group, about 20 000 natural individuals over 35 years old in Beijing area were screened for CRC by sequential fecal occult blood test from March to June, 2001. All CRC patients in both groups were identified by surgical specimens histologically. Results: The CRC patients who were older than 50 years in the clinically diagnosed group and mass screening group were 81.9% and 83.3%, respectively. Cases of Dukes A and B were 41.1% in clinically diagnosed group but 91.7% in mass screening group (P<0.001). The incidence of CRC in mass screening population with and without high risk factors was 0.28% and 0.05%, respectively (P<0.001). In clinically diagnosed group, 44.7% of endoscopic protruding type of CRC was found in Dukes A or B cases, but only 10.0% of ulcerative type was found in Dukes A or B cases (P<0.001); The positivity rate of fecal occult blood test (FOBT) in Dukes A+B cases was 78.5%, and in Dukes C+D 81.9% (P>0.05); There was no correlation between the positivity rate of FOBT and CRC stages; The positivity rate of serum CEA in Dukes C+D cases was significantly higher than that in Dukes A+B (P=0.019); 51.8% of well- or moderately-differentiated carcinomas and 26.5% of poorly-differentiated carcinomas were in Dukes A or B stage (P<0.001). Conclusions: The incidence of CRC in Beijing area is rising rapidly in the past decades. Mass screening of natural population is an effective approach for early detection of CRC. Depending on the clinical manifestations, endoscopic features, laboratory tests, and histological findings, the stages of CRC and the prognosis may be determined.
出处
《胃肠病学》
2004年第3期145-149,共5页
Chinese Journal of Gastroenterology
