Analysis of Screening Data for Colorectal Cancer in Residents in Pudong New Area, Shanghai, 2013-2023
-
摘要:目的
分析上海市浦东新区居民大肠癌筛查基本情况，为大肠癌筛查项目推广和策略优化提供参考。
方法以2013—2023年上海市浦东新区参加大肠癌筛查项目的50~74岁居民为研究对象，分析初筛和肠镜检查情况，同时根据年龄开展亚组分析。组间比较采用卡方检验。
结果2013—2023年浦东新区大肠癌完成社区初筛907 030人次，其中初筛阳性183 724人次，整体初筛阳性率为20.3%，50~54岁年龄组最低，70~74岁年龄组最高，男性初筛阳性率大于女性。总体肠镜检查参与率为27.1%，男、女性肠镜检查参与度最高的年龄段分别为50~54岁和55~59岁，肠镜检查参与率随着每轮筛查的开展有增加趋势。经肠镜检查发现肠道病变19 094例，其中大肠癌1 147例，占6.0%，人群检出率为126.5/10万；癌前病变4 751例，占24.9%，人群检出率为523.8/10万。
结论大肠癌筛查有效提高了癌前病变及早期癌检出率，对于降低大肠癌发病率和死亡率具有重要意义。尚需针对年龄亚组采取措施优化筛查策略，提高初筛参与率和肠镜检查参与率，从而进一步提升大肠癌的防治效果。
Abstract:ObjectiveTo analyze the colorectal cancer screening of community residents in Pudong New Area in Shanghai and provide reference for the promotion and strategy optimization of colorectal cancer screening programs.
MethodsResidents aged 50-74 years in the colorectal cancer screening project of Pudong New Area in Shanghai from 2013 to 2023 were recruited in this analysis. The situation of primary screening and colonoscopy in the community was described, and results of different age groups in primary screening and colonoscopy surveys were evaluated. Chi-square test was used to determine differences between groups.
ResultsFrom 2013 to 2023, 907 030 residents were screened in Pudong New Area, of which 183 724 residents were positive, and the positive rate was 20.3%. The positive rate was the lowest in the 50-54 age group and the highest in the 70-74 age group. The positive rate was higher in men than in women. The overall colonoscopy rate was 27.1%, with the highest rates in the 50-54 age group in men and the 55-59 age group in women, respectively. The participation rate of colonoscopy increased with the increase of the year. A total of 19 094 cases of intestinal lesions were found by colonoscopy. Among these lesions, 1 147 cases were colorectal cancer, accounting for 6.0%, and the population detection rate was 126.5/100 000. In addition, 4 751 cases of precancerous lesions were found, accounting for 24.9%, and the detection rate was 523.8/100 000.
ConclusionColorectal cancer screening improves the detection rate of precancerous lesions and early cancer and is of great significance for reducing the incidence and mortality of colon cancer. Measures should be taken to optimize the screening strategy based on age differences and increase the participation rate of primary screening and colonoscopy to achieve the best effect of local colorectal cancer prevention and treatment.
-
Key words:
- Colorectal cancer /
- Screening /
- Colonoscopy /
- Precancerous lesion /
- Shanghai
-
0 引言
胶质母细胞瘤（glioblastoma multiforme，GBM）为恶性程度最高的星形细胞瘤（属WHO分级的Ⅳ级）。临床上，由于该肿瘤呈浸润性快速生长，多数患者，颅内压迫症状严重，手术清除难度大。即便在手术配合放化疗治疗方案下，绝大多数GBM患者仍因肿瘤复发死亡，中位生存时间只有14~18月[1-2]。临床上，无论是原发或继发GBM患者，肿瘤的基因背景与生物学行为都具有不均一性，因此，每个患者都需进行个体化的治疗决策和预后判断。目前，应用于GBM的临床诊断技术和肿瘤监测手段仍比较单一（主要为影像学技术），存在缺陷，不利于GBM的个体化治疗决策，寻找新的更有效的检测手段迫在眉睫。
近年来，随着生物检测技术的发展，GBM患者血液中检测到肿瘤细胞已是不争的事实[3-4]，这些与GBM的复发密切相关的细胞称为循环肿瘤细胞（circulating tumor cells, CTCs），它们的检测也被誉为“循环活检”。尽管文献报道不多，CTCs的发现给GBM患者的诊治带来了新的希望，它在GBM的早期诊断、肿瘤复发风险评估和预后评估等方面具有潜在的临床应用价值，使GBM诊治的决策更加“有章可循”。本文就胶质母细胞瘤CTCs的一些研究进展综述如下。
1 胶质母细胞瘤CTCs概述
九十年代初，科学家们用免疫细胞化学和克隆形成实验技术检测到乳腺癌患者外周血中的肿瘤细胞后，CTCs的检测和应用逐渐受到重视[5]。迄今已有多项研究表明，GBM患者与一些肿瘤（乳腺癌、前列腺癌、结直肠癌等）患者一样，血液中可以检测到CTCs[3-4, 6-7]。但在外周血中，CTCs受血流剪应力、失巢凋亡和免疫细胞识别杀伤等因素的影响，绝大多数发生死亡[8]，这给CTCs的检测带来了极大的挑战。
有研究认为GBM患者中的CTCs来源于一群具有高度繁殖、自我更新、分化的能力的细胞群体，称为GBM肿瘤干细胞（glioblastoma stem cells, GSC）[8]；GSC具有较高的成瘤潜质，且能够通过神经上皮间质转换过程（glio-mesenchymal transition, GMT）[9]逃脱原发的肿瘤组织，由微脉管入侵循环系统，最后在远处或原发部位种植，完成肿瘤的转移和复发。肿瘤患者血液中幸存的CTCs不仅具有增殖、侵袭和迁移能力，而且具有极强的环境适应能力，对于放化疗具有一定的抵抗性，表现出明显的干细胞特性[10]。这种特性可解释GBM各种治疗效果不理想、易复发、预后极差的原因。
2 CTCs与GBM的复发
绝大多数GBM最终会复发。手术治疗很难做到完全清除肿瘤细胞，其目的更多是为了减轻瘤负荷、缓解症状、明确病理。GBM复发机制复杂，除了与肿瘤的分化程度、手术切除范围、放化疗敏感度等因素有关外，与进入循环的肿瘤细胞也有关，Macarthur等[6]在胶母CTCs的检测中发现，在术后化疗的GBM患者血液中，肿瘤细胞较术前明显减少，遗憾的是该研究未能对患者的预后进行统计分析。
GBM复发的机制有多种观点，有研究认为GBM肿瘤干细胞（GSC）是GBM复发的主要原因。GSC相邻的肿瘤细胞会通过旁分泌和细胞接触等方式抑制GSC，使GSC进入休眠状态。在特定的情况下，如手术、化疗、肿瘤细胞脱落入血等因素影响，使静止的GSC与周围肿瘤细胞隔开，增殖能力将会被重新激活。这种静止又被重新激活的GSC按激活部位的不同分为两类：（1）原发灶的GSC；（2）脱落入血的GSC——CTCs。它们都可能是导致GBM复发的主要因素[11-12]。
研究报道虽然显示GBM极少发生其他器官的转移（仅0.4%的GBM患者伴有肝脏、脾脏、肾脏及皮肤的转移）[13-14]，但是大多数GBM最终都会复发，其中约2/3复发区域位于原发肿瘤附近（≤2 cm），由原发灶的GSC激活所致。而远处复发（> 2 cm）约占1/6的复发性GBM，发生于对侧大脑半球、其他脑叶或幕下等[15]。一些观点认为，远处复发的GBM并非源于原发肿瘤，而是在放化疗或其他因素下诱导发生，属于新原发肿瘤。而一些研究持有不同的观点，认为GBM的复发起源于原发肿瘤，并提出远处复发的肿瘤与原发肿瘤的基因具有一定的相似性[16]。也就是说，CTCs是导致肿瘤在远处复发的原因，这也是复发肿瘤与原发肿瘤基因相似性的原因，放化疗则可能诱导了CTCs的发生。
3 胶质母细胞瘤CTCs检测技术进展
目前，CellSearch系统是美国食品药品监督管理局唯一批准用于临床检测CTCs的产品（主要针对乳腺癌及前列腺癌)[17]，它的应用主要基于CTCs特异的高表达的上皮分子相关抗原（如EpCAM、CK等）。但经过神经上皮间质转换过程（GMT）的胶质母细胞瘤CTCs，EpCAM、CK的表达缺失[18]，使CellSearch系统无法应用于胶质母细胞瘤CTCs与外周血细胞的分离，因此识别胶质母细胞瘤CTCs需要新的免疫分子。所以高敏感、高特异的辨识因子和检测手段标准化应用，是当下胶质母细胞瘤CTCs研究重点所在。
如何检测胶质母细胞瘤CTCs，科学家们设计多种方法。Müller等[3]曾采集141例GBM患者血液，与健康者血液对照，通过离心法富集血液中所有细胞，用胶质原纤维酸性蛋白（glial fibrillary acidic protein, GFAP）免疫染色的方法识别CTCs，结果显示GFAP阳性率为20.6%。而这些GFAP阳性的细胞呈现表皮生长因子受体（epidermal growth factor receptor, EGFR）基因的表达明显上调。Sullivan等[4]通过微流体技术——CTC-iChip富集87例GBM患者血液中的细胞，再用一组胶质瘤标志物（SOX2、tubulinbeta-3、EGFR、A2B5和c-Met）进行CTCs的识别，结果在27例GBM患者血液中发现了CTCs，还发现一些与侵袭性相关的基因（如SERPINE1、TGFB1、TGFBR2和vimentin等）在这些CTCs中高表达。
Macarthur等[6]使用物理离心法富集血细胞，然后用含人端粒酶反转录酶启动子和绿色荧光蛋白（green fluorescent protein, GFP）表达盒的腺病毒感染所得细胞，使细胞能在端粒酶反转录酶的作用下激活（GFP telomerase-based assay），结果发现11例患者中有8例（72%）为CTCs阳性，而在8例经放疗的高级别胶质瘤患者血液中仅1例（12%）CTCs阳性。Zhang等[7]用类似的方法（所选择的病毒不同）检测了290例肿瘤患者及178例正常人血液样本，肿瘤病例包括肺癌、结肠癌、胃癌、肝癌、胰腺癌及胶质瘤，其中CTCs阳性患者为219（75.5%）例，而在39胶质瘤患者中，CTCs阳性为23（59%）例。
4 CTCs应用于GBM的展望
CTCs是否存在于早期的GBM患者血液中目前仍有争议。理论上GBM自形成之后，便存在GMT特性，不断的尝试将自身细胞释放入血，并企图在其他环境下进行无性繁殖[19]。因此，CTCs检测理论上能更早于影像学发现GBM。而临床上占位明确的颅内肿瘤患者，很难对肿瘤进行准确的定性分级，影响GBM患者治疗方案的选择，进而影响了GBM患者的总体预后。因此早期的分类定性GBM，相当于术前肿瘤的活体检查，将会给临床的治疗决策和改善患者的预后带来巨大的收益。例如，在以往不同版本的颅内肿瘤治疗指南中，手术切除、联合放射和化学治疗是治疗GBM的总原则，未经手术的经验型化疗及放疗方案，常因错判治疗的敏感度而延误最佳治疗时期，不仅影响治疗效果，而且增加患者经济负担。而术前CTCs的检测可以在基因和细胞层面早期评估肿瘤恶性程度，使临床工作者更迅速地预知放疗和化疗个体方案对患者治疗的敏感度，更利于肿瘤的规范化、个体化治疗，提高患者疗效，延长总体生存时间，并改善生存质量。
5 小结
GBM由于极差的预后而受到广泛的关注，在手术、放化疗多种方案的结合下，预后仍不良，这是因为GBM的恶性程度高和临床上缺乏及时准确的检测手段。近年来，随着生物检测技术的发展，CTCs被证明存在于GBM患者血液中，它具有肿瘤干细胞特性，能够被多种生物标记检测到，但现有的检测技术仍未标准和规范化。
胶质母细胞瘤CTCs的发现让我们看到了新的希望：（1）CTCs有望较影像学更早更及时地发现肿瘤；（2）CTCs有望成为术前准确诊断肿瘤的手段，指导临床治疗工作；（3）CTCs有望成为评估肿瘤复发的关键指标。当下寻找高敏感度的CTCs免疫标志物、优化检测手段是胶质母细胞瘤CTCs检测研究的重难点，目前CTCs的临床价值仍需更大量的研究数据评估。
Competing interests: The authors declare that they have no competing interests.利益冲突声明：所有作者均声明不存在利益冲突。作者贡献：王莹莹：提出选题，研究设计与实施，数据统计分析，文章撰写与修改乔羽、李卓颖：整理数据和统计分析谭玉婷、杨琛、陈涵一、李牧庭：数据收集项永兵：提供方法学支持，提出修改意见，审核文章张 莉：文章修改与审核 -
表 1 2013—2023年上海市浦东新区大肠癌筛查初筛阳性率情况
Table 1 Positive results among participants screened for colorectal cancer in Pudong New Area, Shanghai, 2013–2023
Age
(years)Male Female Total Risk
assessment
positiveFOBT
positiveScreening
positiveNumber
of
screeningPositive
rates* (%)Risk
assessment
positiveFOBT
positiveScreening
positiveNumber
of
screeningPositive
rates* (%)Risk
assessment
positiveFOBT
positiveScreening
positiveNumber
of
screeningPositive
rates* (%)50-54 1 573 2 401 3 729 23 946 15.6 4 269 4 229 8 016 50 730 15.8 5 842 6 630 11 745 74 676 15.7 55-59 4 170 6 603 10 023 53 318 18.8 9 543 9 830 17 995 99 788 18.0 13 713 16 433 28 018 153 106 18.3 60-64 9 175 13 231 20 629 95 025 21.7 14 793 15 288 27 827 136 554 20.4 23 968 28 519 48 456 231 579 20.9 65-69 13 153 16 495 27 100 124 241 21.8 18 113 17 732 33 025 159 509 20.7 31 266 34 227 60 125 283 750 21.2 70-74 8 752 9 753 16 793 75 904 22.1 10 507 9 819 18 587 88 015 21.1 19 259 19 572 35 380 163 919 21.6 Total 36 823 48 483 78 274 372 434 21.0 57 225 56 898 105 450 534 596 19.7 94 048 105 381 183 724 907 030 20.3 Notes: *: Positive rate=(number of screening positive/numbers of screening)×100%. FOBT: fecal occult blood test. 
下载: 导出CSV
表 2 2013—2023年上海市浦东新区大肠癌筛查肠镜参与率情况
Table 2 Colonoscopy participation results for colorectal cancer screening in Pudong New Area, Shanghai, 2013–2023
Items Male Female Total Number of
enteroscopePositive
casesParticipation
rates (%)Number of
enteroscopePositive
casesParticipation
rates (%)Number of
enteroscopePositive
casesParticipation
rates (%)Age (years) 50-54 1 186 3 729 31.8 2 128 8 016 26.5 3 314 11 745 28.2 55-59 3 184 10 023 31.8 4 983 17 995 27.7 8 167 28 018 29.1 60-64 6 438 20 629 31.2 7 501 27 827 27.0 13 939 48 456 28.8 65-69 7 544 27 100 27.8 8 058 33 025 24.4 15 602 60 125 25.9 70-74 4 392 16 793 26.2 4 310 18 587 23.2 8 702 35 380 24.6 Year First round(2013) 5 037 15 658 32.2 6 607 22 982 28.7 11 644 38 640 30.1 Second round(2014-2016) 6 449 24 095 26.8 7 466 32 721 22.8 13 915 56 816 24.5 Third round(2017-2019) 6 142 21 278 28.9 7 050 27 658 25.5 13 192 48 936 27.0 Fourth round(2020-2022) 3 667 12 726 28.8 4 165 16 125 25.8 7 832 28 851 27.1 Fifth round(2023) 1 449 4 517 32.1 1 692 5 964 28.4 3 141 10 481 30.0 Total 22 744 78 274 29.1 26 980 105 450 25.6 49 724 183 724 27.1
下载: 导出CSV
表 3 2013—2023年上海市浦东新区居民肠镜检出率情况
Table 3 Colonoscopy detection results among participants in Pudong New Area, Shanghai, 2013–2023
Age
(years)Cancer Precancerous
lesion*Inflammatory
polypsHyperplastic
polypsEnteritis Other Total N Rates
(/100000 )N Rates
(/100000 )N Rates
(/100000 )N Rates
(/100000 )N Rates
(/100000 )N Rates
(/100000 )N Rates
(/100000 )50-54 31 41.5 241 322.7 195 261.1 389 520.9 88 117.8 39 52.2 983 1 316.4 55-59 108 70.5 659 430.4 560 365.8 1 022 667.5 232 151.5 128 83.6 2 709 1 769.4 60-64 266 114.9 1 366 589.9 1 037 447.8 1 981 855.4 405 174.9 167 72.1 5 222 2 255.0 65-69 410 144.5 1 582 557.5 1 331 469.1 2 430 856.4 450 158.6 225 79.3 6 428 2 265.4 70-74 332 202.5 903 550.9 766 467.3 1 420 866.3 214 130.6 117 71.4 3 752 2 288.9 Total 1 147 126.5 4 751 523.8 3 889 428.8 7 242 798.4 1 389 153.1 676 74.5 19 094 2 105.1 Notes: *: precancerous lesions include tubular adenomas, villous adenomas, tubular villous adenomas, sessile (broad-based) serrate adenomas, traditional serrate adenomas, hamartomatous polyps, and intraepithelial neoplasia.
下载: 导出CSV
-
[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263. doi: 10.3322/caac.21834
[2] Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53. doi: 10.1016/j.jncc.2024.01.006
[3] 顾凯, 庞怡, 吴春晓, 等. 2017年上海市恶性肿瘤发病和死亡情况与2002—2017年的变化趋势分析[J]. 肿瘤, 2023, 43(4): 241-256. [Gu K, Pang Y, Wu CX, et al. Analysis of the current status of cancer incidence and mortality in Shanghai, 2017 and trends of 2002-2017[J]. Zhong Liu, 2023, 43(4): 241-256.] doi: 10.3781/j.issn.1000-7431.2023.2303-0120 Gu K, Pang Y, Wu CX, et al. Analysis of the current status of cancer incidence and mortality in Shanghai, 2017 and trends of 2002-2017[J]. Zhong Liu, 2023, 43(4): 241-256. doi: 10.3781/j.issn.1000-7431.2023.2303-0120
[4] 李小攀, 杨黎明, 孙乔, 等. 上海市浦东新区居民肾癌患者生存率影响因素分析[J]. 中华肿瘤防治杂志, 2013, 20(9): 667-670. [Li XP, Yang LM, Sun Q, et al. Analysis on factors as sociated with the survival rate of the patients with sporadic renal carcinoma in Pudong new area[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi, 2013, 20(9): 667-670.] doi: 10.3969/j.issn.1673-5269.2013.21.003 Li XP, Yang LM, Sun Q, et al. Analysis on factors as sociated with the survival rate of the patients with sporadic renal carcinoma in Pudong new area[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi, 2013, 20(9): 667-670. doi: 10.3969/j.issn.1673-5269.2013.21.003
[5] Holme Ø, Loberg M, Kalager M, et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial[J]. JAMA, 2014, 312(6): 606-615. doi: 10.1001/jama.2014.8266
[6] Meester RG, Doubeni CA, Zauber AG, et al. Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018[J]. Cancer, 2015, 121(13): 2281-2285. doi: 10.1002/cncr.29336
[7] Atkin W, Wooldrage K, Parkin DM, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial[J]. Lancet, 2017, 389(10076): 1299-1311. doi: 10.1016/S0140-6736(17)30396-3
[8] Brenner H, Kloor M, Pox CP. Colorectal cancer[J]. Lancet, 2014, 383(9927): 1490-1502. doi: 10.1016/S0140-6736(13)61649-9
[9] Giorgi Rossi P, Vicentini M, Sacchettini C, et al. Impact of screening program on incidence of colorectal cancer: a cohort study in Italy[J]. Am J Gastroenterol, 2015, 110(9): 1359-1366. doi: 10.1038/ajg.2015.240
[10] Navarro M, Nicolas A, Ferrandez A, et al. Colorectal cancer population screening programs worldwide in 2016: An update[J]. World J Gastroenterol, 2017, 23(20): 3632-3642. doi: 10.3748/wjg.v23.i20.3632
[11] Montminy EM, Karlitz JJ, Landreneau SW. Progress of colorectal cancer screening in United States: past achievements and future challenges[J]. Prev Med, 2019, 120: 78-84.
[12] 龚杨明, 顾凯, 彭鹏, 等. 社区居民大肠癌筛查工作规范解读[J]. 上海预防医学, 2017, 29(2): 99-101. [Gong YM, Gu K, Peng P, et al. Interpretation of colorectal cancer screening norms for community residents[J]. Shanghai Yu Fang Yi Xue, 2017, 29(2): 99-101.] Gong YM, Gu K, Peng P, et al. Interpretation of colorectal cancer screening norms for community residents[J]. Shanghai Yu Fang Yi Xue, 2017, 29(2): 99-101.
[13] 高淑娜, 陈铭灵, 李为翊, 等. 2013年上海市黄浦区社区居民大肠癌筛查结果分析[J]. 环境与职业医学, 2017, 34(9): 797-800. [Gao SN, Chen ML, Li WY, et al. Analysis on colorectal cancer screening results in community residents in Huangpu District of Shanghai, 2013[J]. Huan Jing Yu Zhi Ye Yi Xue, 2017, 34(9): 797-800.] Gao SN, Chen ML, Li WY, et al. Analysis on colorectal cancer screening results in community residents in Huangpu District of Shanghai, 2013[J]. Huan Jing Yu Zhi Ye Yi Xue, 2017, 34(9): 797-800.
[14] 吴春晓, 龚杨明, 顾凯, 等. 2016年上海市结肠直肠癌发病和死亡情况与2002—2016年间的变化趋势分析[J]. 外科理论与实践, 2021, 26(4): 325-335. [Wu CX, Gong YM, Gu K, et al. Colorectal cancer incidence and mortality in Shanghai 2016 and trend analysis 2002-2016[J]. Wai Ke Li Lun Yu Shi Jian, 2021, 26(4): 325-335.] Wu CX, Gong YM, Gu K, et al. Colorectal cancer incidence and mortality in Shanghai 2016 and trend analysis 2002-2016[J]. Wai Ke Li Lun Yu Shi Jian, 2021, 26(4): 325-335.
[15] Moss S, Ancelle-Park R, Brenner H. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Evaluation and interpretation of screening outcomes[J]. Endoscopy, 2012, 44 Suppl 3: SE49-64.
[16] Logan RF, Patnick J, Nickerson C, et al. Outcomes of the bowel cancer screening programme (BCSP) in England after the first 1 million tests[J]. Gut, 2012, 61(10): 1439-1446. doi: 10.1136/gutjnl-2011-300843
[17] Major D, Bryant H, Delaney M, et al. Colorectal cancer screening in Canada: results from the first round of screening for five provincial programs[J]. Curr Oncol, 2013, 20(5): 252-257. doi: 10.3747/co.20.1646
[18] 曹泮悬, 沈永洲, 黄彦钦, 等. 浙江省海宁市40~74岁目标人群结直肠癌早诊早治筛查结果分析[J]. 中国肿瘤, 2017, 26(3): 181-184. [Cao PX, Shen YZ, Huang YQ, et al. Early diagnosis and early treatment of colorectal cancer in the target population of 40-74 years old in Haining city[J]. Zhongguo Zhong Liu, 2017, 26(3): 181-184.] doi: 10.11735/j.issn.1004-0242.2017.03.A004 Cao PX, Shen YZ, Huang YQ, et al. Early diagnosis and early treatment of colorectal cancer in the target population of 40-74 years old in Haining city[J]. Zhongguo Zhong Liu, 2017, 26(3): 181-184. doi: 10.11735/j.issn.1004-0242.2017.03.A004
[19] 袁平, 顾晋. 2006—2015年中国大肠癌筛查人群依从性的Meta分析[J]. 中国肿瘤, 2017, 26(4): 241-248. [Yuan P, Gu J. Meta-analysis of the Compliance of Colorectal Cancer Screening in China, 2006-2015[J]. Zhongguo Zhong Liu, 2017, 26(4): 241-248.] doi: 10.11735/j.issn.1004-0242.2017.04.A001 Yuan P, Gu J. Meta-analysis of the Compliance of Colorectal Cancer Screening in China, 2006-2015[J]. Zhongguo Zhong Liu, 2017, 26(4): 241-248. doi: 10.11735/j.issn.1004-0242.2017.04.A001
[20] 任建松, 石菊芳, 张洪召, 等. 2012—2013年中国城市人群大肠癌筛查结果初步分析[J]. 中华预防医学杂志, 2015, 49(5): 441-443. [Ren JS, Shi JF, Zhang HZ, et al. Preliminary analysis of the colorectal cancer screening among urban populations in China, 2012-2013[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2015, 49(5): 441-443.] Ren JS, Shi JF, Zhang HZ, et al. Preliminary analysis of the colorectal cancer screening among urban populations in China, 2012-2013[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2015, 49(5): 441-443.
[21] 李燕, 刘华章, 梁颖茹, 等. 广州市2015—2016年50~74岁社区人群大肠癌筛查结果分析[J]. 中华流行病学杂志, 2018, 39(1): 81-85. [Li Y, Liu HZ, Liang YR, et al. Analysis of community colorectal cancer screening in 50-74 years old people in Guangzhou, 2015-2016[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2018, 39(1): 81-85.] doi: 10.3760/cma.j.issn.0254-6450.2018.01.017 Li Y, Liu HZ, Liang YR, et al. Analysis of community colorectal cancer screening in 50-74 years old people in Guangzhou, 2015-2016[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2018, 39(1): 81-85. doi: 10.3760/cma.j.issn.0254-6450.2018.01.017
[22] 赵丽中, 张伟华, 马东旺, 等. 天津市大肠癌筛查初步结果分析[J]. 中国肿瘤临床, 2015, 42(15): 760-764. [Zhao LZ, Zhang WH, Ma DW, et al. Analysis of colorectal cancer screening practices in the general population of Tianjin[J]. Zhongguo Zhong Liu Lin Chuang, 2015, 42(15): 760-764.] Zhao LZ, Zhang WH, Ma DW, et al. Analysis of colorectal cancer screening practices in the general population of Tianjin[J]. Zhongguo Zhong Liu Lin Chuang, 2015, 42(15): 760-764.
[23] 王巧燕, 彭慧, 黄芳, 等. 上海市嘉定区2013—2017年大肠癌筛查结果分析[J]. 中国肿瘤, 2018, 27(9): 647-651. [Wang QY, Peng H, Huang F, et al. Results of colorectal cancer screening in Shanghai Jiading district, 2013-2017[J]. Zhongguo Zhong Liu, 2018, 27(9): 647-651.] doi: 10.11735/j.issn.1004-0242.2018.09.A002 Wang QY, Peng H, Huang F, et al. Results of colorectal cancer screening in Shanghai Jiading district, 2013-2017[J]. Zhongguo Zhong Liu, 2018, 27(9): 647-651. doi: 10.11735/j.issn.1004-0242.2018.09.A002
[24] 郑亦青. 老年人大肠癌筛查的动态分析及依从性研究[D]. 上海: 上海交通大学, 2016: 9-14. [Zheng YQ. Dynamic observation and analysis on colorectal cancer screening in the elderly[D]. Shanghai: Shanghai Jiao Tong University, 2016: 9-14.] Zheng YQ. Dynamic observation and analysis on colorectal cancer screening in the elderly[D]. Shanghai: Shanghai Jiao Tong University, 2016: 9-14.
[25] Menees SB, Inadomi JM, Korsnes S, et al. Women patients' preference for women physicians is a barrier to colon cancer screening[J]. Gastrointest Endosc, 2005, 62(2): 219-223. doi: 10.1016/S0016-5107(05)00540-7
[26] 郑莹, 龚杨明, 顾凯, 等. 上海市社区居民大肠癌筛查项目[J]. 上海预防医学, 2016, 28(10): 739-742. [Zheng Y, Gong YM, Gu K, et al. Community colorectal cancer screening program in Shanghai[J]. Shanghai Yu Fang Yi Xue, 2016, 28(10): 739-742.] Zheng Y, Gong YM, Gu K, et al. Community colorectal cancer screening program in Shanghai[J]. Shanghai Yu Fang Yi Xue, 2016, 28(10): 739-742.
[27] 陈宏达, 李霓, 任建松, 等. 中国城市结直肠癌高危人群的结肠镜筛查依从性及其相关因素分析[J]. 中华预防医学杂志, 2018, 52(3): 231-237. [Chen HD, Li N, Ren JS, et al. Compliance rate of screening colonoscopy and its associated factors among high-risk populations of colorectal cancer in urban China[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2018, 52(3): 231-237.] doi: 10.3760/cma.j.issn.0253-9624.2018.03.004 Chen HD, Li N, Ren JS, et al. Compliance rate of screening colonoscopy and its associated factors among high-risk populations of colorectal cancer in urban China[J]. Zhonghua Yu Fang Yi Xue Za Zhi, 2018, 52(3): 231-237. doi: 10.3760/cma.j.issn.0253-9624.2018.03.004
[28] 李小强, 王莹莹, 陶沙, 等. 上海浦东新区大肠癌不同初筛模式肠镜检查顺应性[J]. 中华肿瘤防治杂志, 2019, 26(2): 75-81. [Li XQ, Wang YY, Tao S, et al. Colonoscopy compliance in high risk population identified by different screening modalities: colorectal cancer screening program in Pudong New Area of Shanghai[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi, 2019, 26(2): 75-81.] Li XQ, Wang YY, Tao S, et al. Colonoscopy compliance in high risk population identified by different screening modalities: colorectal cancer screening program in Pudong New Area of Shanghai[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi, 2019, 26(2): 75-81.
[29] Huei-Yu Wang J, Ma GX, Liang W, et al. Physician intervention and Chinese Americans' colorectal cancer screening[J]. Am J Health Behav, 2018, 42(1): 13-26. doi: 10.5993/AJHB.42.1.2
[30] Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3): 145-164. doi: 10.3322/caac.21601
[31] 蒋鸣孝, 李剑, 黄旭云. 上城区结直肠癌筛查结果分析[J]. 预防医学, 2024, 36(6): 501-505. [Jiang MX, Li J, Huang XY. Analysis of colorectal cancer screening results in Shang cheng district[J]. Yu Fang Yi Xue, 2024, 36(6): 501-505.] Jiang MX, Li J, Huang XY. Analysis of colorectal cancer screening results in Shang cheng district[J]. Yu Fang Yi Xue, 2024, 36(6): 501-505.
[32] 赵丽中, 王秋伟, 于紫婷, 等. 2012—2022年天津市结直肠癌筛查结果分析[J]. 中国肿瘤, 2023, 32(9): 669-675. [Zhao LZ, Wang QW, Yu ZT, et al. Analysis of colorectal cancer screening results in Tianjin from 2012 to 2022[J]. Zhongguo Zhong Liu, 2023, 32(9): 669-675.] doi: 10.11735/j.issn.1004-0242.2023.09.A004 Zhao LZ, Wang QW, Yu ZT, et al. Analysis of colorectal cancer screening results in Tianjin from 2012 to 2022[J]. Zhongguo Zhong Liu, 2023, 32(9): 669-675. doi: 10.11735/j.issn.1004-0242.2023.09.A004
[33] 朱云峰, 陆恩宁, 高田静, 等. 浙江省海宁市两轮40~74岁目标人群结直肠癌筛查结果对比研究[J]. 中国肿瘤, 2024, 33(4): 277-286. [Zhu YF, Lu EN, Gao TJ, et al. Comparison of two rounds of colorectal cancer screening results in target population aged 40-74 years old in Haining city of Zhejiang province[J]. Zhongguo Zhong Liu, 2024, 33(4): 277-286.] doi: 10.11735/j.issn.1004-0242.2024.04.A004 Zhu YF, Lu EN, Gao TJ, et al. Comparison of two rounds of colorectal cancer screening results in target population aged 40-74 years old in Haining city of Zhejiang province[J]. Zhongguo Zhong Liu, 2024, 33(4): 277-286. doi: 10.11735/j.issn.1004-0242.2024.04.A004
[34] Parente F, Boemo C, Ardizzoia A, et al. Outcomes and cost evaluation of the first two rounds of a colorectal cancer screening program based on immunochemical fecal occult blood test in northern Italy[J]. Endoscopy, 2013, 45(1): 27-34.
[35] Pellat A, Deyra J, Coriat R, et al. Results of the national organised colorectal cancer screening program with FIT in Paris[J]. Sci Rep, 2018, 8(1): 4162. doi: 10.1038/s41598-018-22481-9
计量
- 文章访问数: 710
- HTML全文浏览量: 278
- PDF下载量: 125
