Malignant tumors (commonly referred to as cancer) represent a major global public health challenge and contribute significantly to the worldwide disease burden. Early screening plays a critical role in improving detection rates, enabling timely intervention, and enhancing patient survival rates. However, current cancer screening guidelines primarily focus on site-specific screening, which may not fully address the need for comprehensive early detection. A scientifically rational, multi-cancer screening approach offers several advantages: it optimizes the use of biological samples, reduces time costs for participants, enhances the efficiency and comprehensiveness of screening, and minimizes overall expenses. Such an approach also facilitates the rational allocation of healthcare resources, ultimately helping to reduce the societal burden of cancer. To address this need, the Cancer Epidemiology Committee of the Chinese Anti-Cancer Association has developed the Expert Consensus on Combined Screening for Common Cancers in China. This consensus integrates multidisciplinary expertise and synthesizes the latest domestic and international researches on cancer screening, early detection, and treatment for prevalent malignancies. Drawing upon China's unique demographic and healthcare context, as well as practical screening experiences, the consensus provides evidence-based recommendations on target populations, screening technologies, and procedural workflows for multi-cancer screening. These guidelines align with the principles and methodologies established by the World Health Organization (WHO), aiming to enhance the effectiveness of combined cancer screening in China, improve early detection rates, and provide a scientific foundation for national cancer prevention and control strategies.
[目的]探讨我国结直肠癌发病相关影响因素及多种因素联合暴露与结直肠癌发病风险的关联.[方法]基于中国慢性病及其危险因素监测项目数据与中国肿瘤登记数据链接、匹配后的数据库开展巢式病例对照研究.共纳入结直肠癌病例755例,1∶4匹配对照共3 004例.采用条件Logistic回归模型计算各因素与结直肠癌发病风险的比值比(OR)和95％置信区间(CI),并基于弗明汉风险评分函数计算每个个体不同因素联合暴露评分.[结果]在校正多种混杂因素后,目前吸烟(OR=1.765,95％CI:1.408～2.211)、目前饮酒(OR=1.370,95％CI:1.122～1.674)、日均静坐时长超过 4 h(OR=1.843,95％CI:1.382～2.456)、体质指数(body mass index,BMI)为超重(OR=1.241,95％CI:1.027～1.501)或肥胖(OR=1.564,95％CI:1.217～2.009)、每天吃红肉类食物(OR=1.445,95％CI:1.185～1.763)、不经常吃蔬菜(OR-.1.650,95％CI:1.196～2.278)、患有高血压(OR=1.634,95％CI:1.350～1.978)和糖尿病(OR=1.749,95％CI:1.389～2.204)以及有癌症家族史(OR=1.880,95％CI:1.324～2.668)为结直肠癌发病危险因素.联合暴露评分结果显示,最高四分位数组发生结直肠癌的风险为第一四分位数组的4.186倍(95％CI:3.192～5.490).[结论]目前吸烟、饮酒者、久坐、超重或肥胖且有不良饮食习惯者以及患有高血压、糖尿病、有癌症家族史者是结直肠癌的高危人群,应重点关注.此外,上述多种危险因素联合作用会更为显著地增加结直肠癌发病风险.
[目的]分析2018年甘肃省肿瘤登记地区肺癌流行现状及变化趋势.[方法]按性别、城乡和年龄组分层计算肺癌发病(死亡)率、中国人口标化率(中标率)、世界人口标化率(世标率)及年龄别率等指标,描述2018年肺癌流行特征;利用Joinpoint线性回归模型计算年度变化百分比(APC),分析2010-2018年肺癌年度变化趋势.[结果]2018年甘肃省肿瘤登记地区肺癌新发病例数为640例,发病率为30.10/10万,中标率为22.03/10万,世标率为24.87/10万,0～74岁累积率为2.74％;肺癌死亡病例数为515例,死亡率为24.22/10万,中标率为18.18/10万,世标率为21.03/10万,0～74岁累积率为2.18％;农村发病率为城市的1.61倍,死亡率是城市的1.91倍;肺癌男性年龄别发病率和死亡率分别在80～84岁和75～79岁年龄组达到最高峰,女性在75～79岁和85岁及以上年龄组达到最高峰;肺癌发病和死亡情况地区分布情况显示,景泰县发病率和死亡率均为最高,武威市凉州区均为最低.2010-2018年甘肃省肿瘤登记地区肺癌中标发病率APC为0.60％(95％CI:-1.31％～2.55％),中标死亡率APC为4.80％(95％CI:-2.23％～12.35％),变化趋势差异均无统计学意义(P＞0.05).[结论]甘肃省肺癌发病及死亡率虽低于全国平均水平,但仍属于甘肃省高发癌种,已严重威胁居民生命健康,应积极推进肺癌高危人群评估及筛查早诊早治工作,有效遏制肺癌的高发态势.
PD-1/PD-L1抑制剂在乳腺癌免疫治疗中的应用已逐渐成为一种重要的治疗手段,然而对乳腺癌,尤其是三阴性乳腺癌(TNBC)的免疫治疗仍存在某些亟待解决的科学问题,包括PD-1/PD-L1抑制剂单药治疗的有效率欠佳,目前尚无明确的生物标志物来有效筛查治疗敏感人群,免疫相关不良反应(irAE)的发生率高.为了提高疗效和减少irAE的发生,采取以下措施是非常重要的:探讨PD-1/PD-L1抑制剂与其他药物的联合应用方案;采用纳米技术开发选择性靶向肿瘤细胞的纳米载体,降低抗肿瘤药物毒性并提高疗效;探寻开发可预测免疫治疗反应潜力的生物标志物;早期识别和诊疗irAE并建设多学科诊疗协作组(MDT)模式.随着这些措施的积极推进和问题的不断解决,PD-1/PD-L1抑制剂在乳腺癌的治疗中必将呈现出更为广阔的应用前景.
例1 女性,72岁,2016年1月行直肠中分化腺癌根治术,术后分期T3N1M0期,Ⅲb期.免疫组化染色显示,人表皮生长因子受体2(human epidermal growth factor receptor-2, HER-2)强阳性(3+,图1).
