食管癌高发区山东省肥城市2006年至2016年食管癌前病变转归情况分析

高冬青; 史思达; 杨佳; 张楠; 王家林

doi:10.3969/j.issn.1000-8179.2020.22.015

食管癌高发区山东省肥城市2006年至2016年食管癌前病变转归情况分析

doi: 10.3969/j.issn.1000-8179.2020.22.015

高冬青^{①, ②,},
史思达^③,
杨佳^{①, ②},
张楠^④,
王家林^②, ,

①.
山东第一医科大学(山东省医学科学院) (济南市 250000)
②.
山东省肿瘤防治研究院(山东省肿瘤医院), 山东第一医科大学(山东省医学科学院)人力资源部
③.
山东省肿瘤防治研究院(山东省肿瘤医院), 山东省抗癌协会
④.
山东省肿瘤防治研究院(山东省肿瘤医院)预防管理部

基金项目:

国家重点研发计划项目 2016YFC1302800

国家重点研发计划项目 2016YFC0901400

国家自然科学基金 81573246

国家自然科学基金 71904109

山东省自然科学基金 ZR2019PG006

详细信息

作者简介:
高冬青专业方向为肿瘤流行病学。E-mail:18766195657@163.com

通讯作者:
王家林 wangjialin6681@163.com

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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-17
- 刊出日期: 2020-12-26

Analysis of the outcomes of esophageal precancerous lesions between 2006 and 2016 in Feicheng City, a high-incidence area of esophageal cancer

Gao Dongqing^{①, ②
,},
Shi Sida^③,
Yang Jia^{①, ②},
Zhang Nan^④,
Wang Jialin^{②
, ,}

①.
Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250000, China
②.
Department of Human Resources, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
③.
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Shandong Anti-Cancer Association, Jinan 250117, China
④.
Department of Prevention Management, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan 250117, China

Funds:

National Key Research and Development Program 2016YFC1302800

National Key Research and Development Program 2016YFC0901400

National Natural Science Foundation of China 81573246

National Natural Science Foundation of China 71904109

Natural Science Foundation of Shandong Province ZR2019PG006

More Information

Corresponding author: Jialin Wang; E-mail:wangjialin6681@163.com

摘要

摘要: 目的研究食管癌高发区中国山东省肥城市食管癌前病变自然转归情况，为食管癌前病变及食管鳞癌的防治工作提供科学依据。方法回顾性收集山东省肥城市2006年至2016年期间进行内镜病理诊断且未治疗并进行二次内镜随访的受检者资料进行分析，描述癌前病变病例的具体复查结果，计算进展病例的累积进展率和进展时间，分析食管癌前病变病例的转归情况。结果本研究共纳入1 834例食管癌前病变病例，其中1 148例（62.6%）癌前病变发生逆转，148例（8.1%）发生进展。逆转为正常状态的病例共234例（12.8%），进展为食管癌共17例（0.9%）。各级别癌前病变进展为食管癌的病例比例由高至低依次为：重度异型增生/原位癌（4.9%）、中度异型增生（1.3%）、轻度异型增生（0.2%）；其发生癌变的中位进展时间由高至低依次为：轻度异型增生（5.62年）、中度异型增生（1.76年）和重度异型增生/原位癌（1.61年）。轻度异型增生9年累积进展为重度异型增生/原位癌及以上的进展率远小于中度异型增生（1.81% vs.9.98%），重度异型增生/原位癌进展为食管癌的累积进展率始终高于中度和轻度异型增生。结论超过一半以上的癌前病变会逆转为较低级别病变或正常状态；食管癌前病变的累积癌变率随病变级别的增高而增大，中位进展时间随病变级别的增高而缩短。大多数癌前病变进展为食管癌的时间间隔基本与《癌症早诊早治上消化道癌筛查及早诊早治技术方案》中的随访间隔相符，可适当对轻度异型增生患者的随访间隔缩短为每2年1次。
- 食管鳞癌 /
- 癌前病变 /
- 转归 /
- 筛查间隔
Abstract: Objective Studying the prognosis of esophageal precancerous lesions in Feicheng City and to provide scientific basis for the prevention and control of esophageal squamous cell carcinomas. Methods Retrospective analyze the data of subjects who were not given any medical treatment after endoscopic pathological diagnosis and accepted secondary endoscopic follow-up screening in oFeicheng City from 2006-2016. Describe the results of reexaminations and calculate the cumulative progression rate and progression time to analysis the outcomes of esophageal precancerous lesions. Results A total of 1, 834 cases of precancerous esophageal lesions were included in our study, of which 1, 148 (62.6%) were reversed and 148 (8.1%) were advanced. A total of 234 (12.8%) cases were reversed to normal state, and 17 (0.9%)cases progressed to esophageal cancer. The proportions of precancerous lesions progressing to esophageal cancer from high to low are: severe dysplasia/carcinoma in situ (4.9%), moderate dysplasia (1.3%), mild dysplasia (0.2%); and the median times of cancerous changes from high to low are: mild dysplasia (5.62 years), moderate dysplasia (1.76 years) and severe dysplasia/carcinoma in situ (1.61 years). The 9-year cumulative progression of mild dysplasia to severe dysplasia/carcinoma in situ and above is much less than moderate dysplasia (1.81% vs. 9.98%). The cumulative carcinoma progression rate of severe dysplasia/carcinoma in situ was consistently higher than that of moderate and mild esophageal carcinoma. Conclusions More than half of the precancerous lesions will be reversed to normal or lower-grade lesions. The cumulative carcinogenesis rate of esophageal precancerous lesions increased with the grade of the lesion, and the median time to progression decreased with increasing lesion grade. The time interval for most precancerous lesions to progress to esophageal cancer was roughly consistent with the follow-up interval in the technical plan for the early diagnosis and treatment of cancer. The follow-up frequency for patients with mild dysplasia should be reduced to once every two years.
- esophageal squamous cell carcinoma /
- precancerous lesions /
- outcomes /
- screening interval

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图 1 各级癌前病变进展规律

下载: 全尺寸图片幻灯片

表 1 筛查前研究对象一般人口学特征

表 2 食管癌前病变转归情况

表 3 食管癌前病变进展规律

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