Vulvar and vaginal cancers significantly impact women’s health and quality of life. This study analyzes the prevalence of human papillomavirus (HPV), clinicopathological characteristics, treatment patterns, and survival outcomes, to understand their relationships and better guide prevention and therapy for Chinese patients with vulvar or vaginal cancer. We conducted a retrospective, multicenter study across nine tertiary hospitals located in seven regions of China, including patients diagnosed and treated between 2017 and 2021. Data were collected from medical records and standardized questionnaires, with routine clinical follow-up. Continuous variables were analyzed using the Wilcoxon rank-sum test, while categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Survival outcomes, including overall survival and disease-free survival, were evaluated using the Kaplan-Meier method and multivariable cox proportional hazards regression. A total of 218 patients (131 vulvar, 87 vaginal) were analyzed. HPV infection was significantly higher in vaginal than vulvar cancer (76.1

目的 分析上消化道癌及癌前病变的危险因素,构建上消化道癌高危人群预测模型,识别上消化道癌高危群体.方法 选取2020年6月至2021年12月参加山西省阳城县"农村上消化道癌早诊早治项目"中的40～69岁人群,根据纳入和排除标准筛选后按7∶3随机分为训练集(n=1 997)和验证集(n=852),分别用于模型的训练和验证.采用χ2检验进行单因素分析,P<0.2的因素进行最优子集变量筛选,选择赤池信息(akaike information criterion,AIC)最低的变量组合构建logistic回归模型并建立评分量表.绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)并根据曲线下面积(area under the curve,AUC)评估模型区分度,Hosmer-Lemeshow(H-L)检验和校准曲线评估模型校准度,临床决策曲线(decision curve analysis,DCA)评估临床适用性.结果 建立基于年龄、性别、吸烟、热烫饮食摄入、肿瘤家族史5项危险因素的上消化道癌及癌前病变logistic回归预测模型,训练集和验证集AUC分别为0.759(95%CI:0.688～0.830)和0.743(95%CI:0.606～0.880),校准曲线结合H-L检验证明该模型具有较好的校准度(P>0.05).根据logistic回归模型建立评分模型,分值范围0～27分,分值越高发病风险越高.评分模型训练集和验证集的AUC分别为0.760(95%CI:0.690～0.829)和0.748(95%CI:0.612～0.884),校准曲线结合H-L检验证明该模型具有较好的校准度(P>0.05).DCA表明该模型具有良好的临床适用性.结论 基于年龄、性别、吸烟、热烫饮食摄入、肿瘤家族史等5个危险因素构成的上消化道癌及癌前病变高危人群预测模型和评分模型具有较好的预测价值,有助于上消化道癌人群筛查.

Colorectal cancer (CRC) risk is influenced by dietary patterns and gut microbiota enterotypes. However, the interaction between these factors remains unclear. This study examines this relationship, hypothesizing that different diets may affect colorectal tumor risk in individuals with varied gut microbiota enterotypes. We conducted a case-control study involving 410 Han Chinese individuals, using exploratory structural equation modeling to identify two dietary patterns, and a Dirichlet multinomial mixture model to classify 250 colorectal neoplasm cases into three gut microbiota enterotypes. We assessed the association between dietary patterns and the risk of each tumor subtype using logistic regression analysis. We found that a healthy diet, rich in vegetables, fruits, milk, and yogurt, lowers CRC risk, particularly in individuals with type I (dominated by Bacteroides and Lachnoclostridium) and type II (dominated by Bacteroides and Faecalibacterium) gut microbiota enterotypes, with adjusted odds ratios (ORs) of 0.66 (95% confidence interval [CI] = 0.48-0.89) and 0.42 (95% CI = 0.29-0.62), respectively. Fruit consumption was the main contributor to this protective effect. No association was found between a healthy dietary pattern and colorectal adenoma risk or between a high-fat diet and colorectal neoplasm risk. Different CRC subtypes associated with gut microbiota enterotypes displayed unique microbial compositions and functions. Our study suggests that specific gut microbiota enterotypes can modulate the effects of diet on CRC risk, offering new perspectives on the relationship between diet, gut microbiota, and colorectal neoplasm risk.

Disability weights are crucial for quantifying health loss associated with non-fatal outcomes and were not well assessed in different countries, especially for specific cancer. Therefore, this study aimed to identify disability weights with a focus on specific cancer in a large Chinese population. Two types of web surveys were conducted, and 254 health states, including 30 new states for specific cancer, were investigated using paired comparison methods. The years lived with disability (YLDs) of cancer were calculated as the sum of the prevalence of each sequela of cancer multiplied by its relative disability weight. In total, 44,069 participants were eligible for the disability weights study. The disability weights of 254 health states were estimated. Among those, the disability weights of 18 specific cancer types varied greatly at diagnosis and primary treatment stage, with the value ranging from 0.619 (95% uncertainty interval (UI) 0.606-0.632) for brain cancer to 0.167 (95% UI 0.158-0.176) for oropharyngeal cancer. The discrepancy in YLDs calculated by different disability weights was high, and the largest gap for all cancer combined was approximately 30.14%. When calculated using the cancer-specific disability weights, a total of 1,967,830 (95% UI 1,928,880-2,008,060) YLDs of cancer were recorded in China. The disability weights of cancer varied greatly among cancer types and populations, which had considerable influence on the estimation of the disease burden. Cancer-specific disability weights could provide a more accurate evaluation of the cancer burden.

Objective:To evaluate the performance of rural practitioners of endoscopic cleaning and disinfection participating in the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers and to analyze the influencing factors.Methods:The questionnaires for skill assessment were designed based on the skill scheme and clinical practice of the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China, and the App Early diagnosis, Early treatment was used as the examination platform. The practitioners in 539 county hospitals from 25 provinces participating in the program in 2019 were assessed for techniques and skills for endoscopic cleaning and disinfection and the excellence rate was calculated. Multivariate logistic regression model was used to analyze the influencing factors for the examination. Results:A total of 1 671 endoscopic cleaning and disinfection practitioners participated in the assessment with the score of 73.41±16.60. The passing rate was 85.82%, and the excellence rate was 44.94%. Among all questions, the correct rate of "opportunistic screening flow chart" was the highest (98.21%), and that of "the evaluation index for mass screening" was the lowest (57.89%). The multivariate logistic regression analysis showed that the excellence rate was high in practitioners who had a bachelor degree or above ( OR=1.627,95% CI:1.319-2.007, P<0.001), the career for 5 to <15 years (5 to <10 years: OR=1.329,95% CI:1.045-1.689, P=0.020; 10 to <15 years: OR=1.384,95% CI:1.026-1.867, P=0.033), working in eastern and central regions (eastern regions: OR=3.476,95% CI:2.368-5.103, P<0.001;central regions: OR=4.028,95% CI:2.679-6.057, P<0.001) and with full understanding of the screening scheme ( OR=1.547,95% CI:1.246-1.921, P<0.001) . Conclusion:Practitioners on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China have mastered the basic screening scheme and skills for endoscopic cleaning and disinfection. The education background, duration of the career, area and understanding of screening scheme are influencing factors for the excellence rate of endoscopic cleaning and disinfection.

Objective:To investigate the incidence and mortality of lung cancer in the cancer registration areas of Shanxi Province in 2017.Methods:The cancer registration data reported by 12 tumor registration areas of Shanxi in 2017 were sorted out and stratified by urban and rural areas and gender. The number of incidence and death ,the crude incidence and mortality, the cumulative rate (0-74 years), age-specific incidence and mortality, Chinese population standardized rate and world population standardized rate were calculated. The incidence and mortality were standardized by the 2000 China census standard population composition and Segi's world standard population composition.Results:In 2017, there were 2 275 new cases and 1 736 deaths of lung cancer in the tumor registration area of Shanxi Province. The crude incidence rate of lung cancer was 46.72/100 000 (male 63.99/100 000, female 28.80/100 000, urban area 58.05/100 000, rural area 39.09/100 000), Chinese population standardized rate was 31.67/100 000, the world population standardized rate was 32.10/100 000, and the cumulative rate (0-74 years) was 3.87/100 000. The crude mortality rate was 35.65/100,000 (male 49.84/100,000, female 20.93/100,000, urban area 44.53/100,000, rural area 29.67/100 000), Chinese population standardized rate was 23.82/100 000, the world population standardized rate was 24.14/100 000, and the cumulative rate (0-74 years) was 2.69/100,000. Overall, the age-specific incidence and mortality of lung cancer in 2017 were at a low level in 0-44 years age group, and increased rapidly after 45 years age group, and reached a peak in 85 years age group. The incidence and mortality of lung cancer in males were higher than that in females. Although there were some differences in the incidence and mortality of patients with different ago range in urban and rural areas, the overall trend was similar.Conclusions:Lung cancer is the most common malignant tumor threatening the health of residents in Shanxi Province. Male, urban areas and middle-aged and elderly population are the focus of cancer prevention and control in Shanxi Province. Lung cancer prevention and control should be targeted carried out according to the differences between urban and rural areas and gender.

Abstract Background Dietary patterns and symptoms research among Chinese with esophageal squamous cell carcinoma (ESCC) and its precursor lesions is limited, especially as it relates to multiple food consumption and multiple co-occurring symptoms. The aim of our study was to identify the dietary patterns and severity of symptom classes with the risk of esophageal squamous cell carcinoma and its histological precursor lesions, and develop a risk prediction model for different stages of esophageal disease. Methods We analyzed data from a multicenter cross-sectional study carried out in ESCC high incidence areas between 2017 and 2018, which included 34,707 individuals aged 40–69 years. Dietary patterns and severity of symptom classes were derived by applying a latent class analysis (LCA). A multiple logistic regression model was used to derive the odds ratio (ORs) and corresponding 95% confidence intervals (CIs) for ESCC and the different stages of esophageal disease according to the dietary patterns and severity of symptom classes identified. We built the risk prediction model by using a nomogram. Results We identified five dietary patterns and three severity of symptom classes. The dietary patterns were classified as follows: “Healthy”, “Western”, “Lower consumers-combination”, “Medium consumers-combination” and “Higher consumers-combination” patterns based on the intake of foods such as red meat, vegetables and fruits. The severity of symptoms was categorized into “Asymptomatic”, “Mild symptoms” and “Overt symptoms” classes based on health-related symptoms reported by the participants. Compared to the “Healthy” pattern, the other four patterns were all associated with an increased risk of esophageal disease. Similarly, the other two symptom classes present different degrees of increased risk of esophageal disease compared to the “Asymptomatic”. The nomograms reflect the good predictive ability of the model. Conclusion Among individuals aged 40–69 years in high incidence regions of upper gastrointestinal cancer, the results supplied that subjects with diets rich in livestock and poultry meat and low in fruits and vegetables and subjects with typical symptoms were at increased ESCC risk. The findings highlight the importance of considering food and symptom combinations in cancer risk evaluation.

[目的]分析2017年山西省肿瘤登记地区的上消化道癌流行现状及2013-2017年的发病率和死亡率趋势变化.[方法]整理2013-2017年山西省肿瘤登记地区上消化道癌发病、死亡数据及人口资料.根据2017年符合质量审核标准的数据,计算上消化道癌的粗发病(死亡)率、中国人口标准化率(简称中标率)、世界人口标准化率(简称世标率)、累积发病(死亡)率(0～74岁)以及年龄别发病(死亡)率,标准人口采用全国2000年普查标准人口构成和Segi's世界标准人口构成.利用Joinpoint 4.9.1.0软件,计算2013-2017年山西省肿瘤登记地区上消化道癌中标发病(死亡)率的年度变化百分比(annual percentage change,APC),了解其时间变化趋势特征.[结果]2017年山西省肿瘤登记地区共有上消化道癌新发病例3 299例,粗发病率为67.76/10万,中标率为46.38/10万,世标率为47.48/10万,累积发病率(0～74岁)为6.21％;上消化道癌死亡病例2 229例,粗死亡率为45.78/10万,中标率为30.95/10万,世标率为31.74/10万,累积死亡率(0～74岁)为3.75％.2017年山西省肿瘤登记地区上消化道癌的发病率和死亡率分别从40～岁和45～岁年龄组开始随着年龄的增加而增长,且呈现出了农村地区高于城市地区、男性高于女性的特点.2013-2017年,山西省肿瘤登记地区上消化道癌中标发病率整体呈下降趋势(APC=-4.08％),城市地区和农村地区上消化道癌的中标发病率均以不同幅度下降(APC为-3.01％和-5.55％),但趋势变化无统计学意义(P＞0.05);山西省肿瘤登记地区上消化道癌中标死亡率整体呈下降趋势(APC=-2.08％),城市地区呈小幅上升趋势(APC=2.11％),农村地区呈下降趋势(APC=-4.55％),但趋势变化无统计学意义(P＞0.05).[结论]2013-2017年山西省肿瘤登记地区上消化道癌的中标发病率和中标死亡率略有下降,但仍处于较高水平.为了提高上消化道癌的整体防治水平,应重点关注男性人群、农村地区人群和40岁以上的人群,加强防控力度,推进上消化道癌早诊早治项目工作,切实降低其疾病负担.

目的:了解农村上消化道癌早诊早治地区基层项目管理人员的技术能力.方法:由农村上消化道癌早诊早治项目专家组依据国家现行技术方案和项目实践,编写考核试题库,利用"早诊早治"APP建立考试平台,收集2019年参加农村上消化道癌早诊早治项目的27个省的418家县级医疗卫生机构项目管理人员的能力水平考核信息进行描述性分析.结果:共有827名基层项目管理人员完成考核,考核平均分83.07分,合格率96.86％,优秀率78.36％.其中"人群数据管理和安全"答题平均正确率最高,为99.52％;"人群筛查质量控制"答题平均正确率最低,为67.21％.结论:我国农村上消化道癌早诊早治地区基层项目管理人员较好掌握技术方案和具备数据管理能力,文化程度高、东中部地区、疾控中心的项目人员考核优秀的比例更高,应针对技术水平较低的人员和认知薄弱的技术环节加强培训.

目的 探讨农村上消化道癌早诊早治地区病理医师技术能力水平及相关影响因素.方法 以2019-01-01-2019-12-31参与农村上消化道癌早诊早治项目的病理医师为研究对象,由项目专家组依据现行技术方案和项目实例编写考核试题库,利用"早诊早治"APP建立考试平台进行技术能力考核,计算考核优秀率.采用多因素Logistic回归模型分析考核优秀率的影响因素.结果 共纳入1304名病理医师进行分析,考核平均分为75.71,合格率为94.40％(1231/1304),优秀率为36.58％(477/1304).对于各部分考核内容的平均答题正确率,其中"标本处理与病理诊断"为(78.84±8.83)％,"肿瘤病理诊断标准"为(71.70±9.85)％,"人群筛查质控"和"评价指标"分别为(65.37±9.22)％和(68.66±32.32)％.多因素分析结果显示,本科及以上文化程度(OR研究生=2.185,95％CI为1.393～3.428,P=0.001;OR本科=1.702,95％CI为1.155～2.507,P=0.007)、本专业工作5～<10年(OR=1.589,95％CI为1.072～2.356,P=0.021)、参加项目≥2年(OR=1.315,95％CI为1.034～1.672,P=0.026)、东中部地区(OR东部=2.558,95％CI为1.660～3.942,P<0.001;OR中部=2.294,95％CI为1.462～3.601,P<0.001)的病理医师考核优秀率相对较高.结论 我国农村上消化道癌早诊早治地区病理医师基本掌握技术方案,但总体优秀率偏低.文化程度、本专业工作时长、参加项目时长和所在地区是病理医师考核优秀的主要影响因素,应有针对性继续加强病理医师培训.

Objective:To realize the understanding level of cancer awareness of residents in Shanxi Province, and to provide a scientific basis for cancer prevention and treatment.Methods:In April 2020, 1 897 local residents in Shanxi Province were recruited to fill in the core knowledge questionnaire of cancer prevention and treatment. The basic demographic information and the core knowledge of cancer prevention and control were collected, and the influencing factors for the understanding of the core knowledge of cancer prevention and treatment were analyzed by using multivariate logistic regression model.Results:In the survey on the awareness rate of core knowledge of cancer prevention and control among residents in Shanxi Province, 37 940 items were answered, among which 29 396 items were known, and the awareness rate of the population was 77.48% (29 396/37 940). The single-factor results showed that there were statistically significant differences in awareness rates of core knowledge of cancer prevention and treatment among the population with different gender, household registration, ethnic groups, education degree, occupation and different frequency of the health examination were statistically significant (all P < 0.05); there were no statistically significant differences in awareness rates of core knowledge among the population with different age, and smokers or non-smokers (all P >0.05).Multivariate logistic regression analysis showed that education degree of junior middle school or above ( OR = 3.412-16.767, 95% CI 1.755-32.476) and receiving physical examination once a year ( OR = 2.291, 95% CI 1.154-4.549) were the favorable factors for knowing the core knowledge of cancer prevention and treatment. Household location in rural area ( OR = 0.522, 95% CI 0.378-0.722) and non-Han nationality ( OR = 0.369, 95% CI 0.151-0.904) were the unfavorable factors for knowing the core knowledge of cancer prevention and treatment. Conclusions:The awareness of core knowledge of cancer prevention and treatment among residents in Shanxi Province is good, so it is necessary to continue to strengthen the publicity of cancer prevention and control and improve the awareness of cancer prevention and control in the future.

[目的]探究农村上消化道癌早诊早治项目筛查内镜医师专业技术能力现状及其影响因素.[方法]由农村上消化道癌早诊早治项目专家组依据国家现行技术方案和项目实践编写考核试题库,并利用"早诊早治"APP建立考试平台,收集2019年参加农村上消化道癌早诊早治项目的内镜医师基本情况,并对内镜医师技术方案掌握情况和内镜诊疗技术能力进行考核,计算考核优秀率.采用多因素Logistic回归模型分析影响考核优秀率的因素.[结果]共3207名内镜医师完成考核,考核平均分(72.60±15.07)分,合格率87.25％,优秀率33.80％.内镜医师对"人群筛查数据管理和安全"相关内容答题平均正确率最高,为99.16％,对"人群筛查评价指标"内容答题平均正确率最低,为59.73％.多因素Logistic回归分析提示,性别、年龄、文化程度、职称、参加项目时长、所在地区和对技术方案理解程度与考核优秀率相关,女性、年龄小于40岁、研究生文化程度、主治医师及以上职称、参加项目2年及以上、东中部地区以及完全理解技术方案的内镜医师考核优秀率相对较高(P均＜0.05).[结论]我国农村上消化道癌筛查内镜医师基本能够掌握技术方案,但总体优秀率偏低,应针对技术能力水平较低的内镜医师和掌握薄弱的技术环节加强培训.

Background Despite research efforts, the causative factors that contribute to esophageal squamous cell carcinoma (ESCC) in high-risk areas have not yet been understood. In this study, we, therefore, aimed to describe the risk factors associated with ESCC and its precursor lesions. Methods We performed an endoscopic examination of 44,857 individuals aged 40–69 years from five high incidence regions of China in 2017–2018. Participants were classified as 4 groups of normal control, esophagitis, low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia/esophageal squamous cell carcinoma (HGIN/ESCC) using an unconditional logistic regression determine risk factors. Results We identified 4890 esophagitis, 1874 LGIN and 437 HGIN/ESCC cases. Crude odds ratios (ORs) and adjusted odds ratios were calculated using unconditional logistic regression. Drinking well and surface water, salty diet, and positive family history of cancer were the common risk factors for esophagitis, LGIN and HGIN/ESCC. History of chronic hepatitis/cirrhosis was the greatest risk factor of esophagitis (adjusted OR 2.96, 95%CI 2.52–3.47) and HGIN/ESCC (adjusted OR 1.91, 95%CI 1.03–3.22). Pesticide exposure (adjusted OR 1.20, 95%CI 1.05–1.37) was essential risk factor of LGIN. Conclusions Among individuals aged 40–69 years in high incidence regions of upper gastrointestinal cancer, the results provided important epidemiological evidence for the prevention of different precancerous lesions of ESCC.

Objectives To determine the incidence and intensity of household impoverishment induced by cancer treatment in China.Design Average income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.Participants Cancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.Data sources A household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.Findings 5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.Conclusions The financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

目的 分析山西省肿瘤登记地区2016年上消化道癌的发病与死亡情况,为上消化道癌的预防和控制提供依据.方法 整理山西省2016年12个肿瘤登记地区上报的肿瘤登记数据,按城乡、性别进行分层,分别计算其发病例数、死亡例数、发病粗率、死亡粗率、累积率(0～74岁)、年龄别发病率、年龄别死亡率,计算中国人口标准化率(中标率),世界人口标准化率(世标率)等指标.标准人口采用2000年中国普查标准人口构成和Segi′s世界标准人口构成.结果 山西省肿瘤登记地区2016年上消化道癌新发病例2940例,死亡病例2135例.上消化道癌发病粗率为60.13/10万(男性80.53/10万,女性38.97/10万,城市地区39.38/10万,农村地区74.17/10万),中标率41.91/10万,世标率42.97/10万,累积率(0～74岁)为5.61/10万;死亡粗率为43.67/10万(男性58.56/10万,女性28.21/10万,城市地区31.67/10万,农村地区51.78/10万),中标率29.94/10万,世标率30.52/10万,累积率(0～74岁)为3.62/10万;总体上,农村地区上消化道癌的发病率和死亡率高于城市地区;男性上消化道癌的发病率和死亡率高于女性;40-岁年龄组以后,上消化道癌发病率呈上升趋势,城市地区发病率在80-岁年龄组达到高峰,农村地区在65-岁年龄组达到高峰;上消化道癌死亡率在45-岁年龄组之前处于较低水平,而后随着年龄的增加而逐渐上升,并在85+岁年龄组达到峰值.结论 上消化道癌是威胁山西省居民健康最常见的恶性肿瘤,男性人群、农村地区人群及中老年群体是我省癌症防控的重点,应根据城乡及性别差异,有针对性地开展上消化道肿瘤防治工作.

[目的]分析山西省2014-2018年城市癌症早诊早治项目的癌症筛查结果.[方法]采取整群随机抽样的方法,选取太原市、阳泉市、晋城市40～74岁常住居民进行患癌风险评估,评估出的高风险对象免费接受相应癌种的临床筛查,分析评估各癌种的高风险率、筛查顺应性和阳性病变检出率.[结果]研究人群整体患癌高风险率为41.37％,其中男性高风险率高于女性,55～59岁人群高风险率最高,各癌种高风险率从高到低依次为:上消化道癌22.46％,肺癌19.94％,乳腺癌17.38％,结直肠癌12.24％,肝癌9.42％;各癌种筛查顺应性从高到低为:乳腺癌(51.33％)、肝癌(43.74％)、肺癌(34.41％)、结直肠癌(21.71％)、上消化道癌(14.53％);临床筛查结果显示,肺癌、上消化道癌和结直肠癌的阳性病变检出率随年龄的增加而增高,45～49岁女性乳腺癌阳性病变检出率较高,男性上消化道癌和结直肠癌的阳性病变检出率高于女性.[结论]人群患癌高风险比例分布与当地癌症发病分布基本一致,筛查顺应性和筛查方法相关,介入性检查顺应性较低.筛查人群高风险率、顺应性以及阳性病变检出率不同性别和不同年龄段存在一定的差异,有针对性地对城市高风险人群进行筛查,能够发现早期癌症患者,从长远来讲将有效降低癌症的发病率和死亡率.

目的 分析2016年山西省肿瘤登记地区居民肝癌发病、死亡情况,为制订肝癌防治策略提供依据.方法 收集山西省12个肿瘤登记地区居民肝癌发病和死亡资料,统计肝癌发病率、死亡率等指标,分别采用2000年中国标准人口年龄构成和Segi's世界标准人口年龄构成计算中标率和世标率,分析不同性别、年龄、以及城乡居民肝癌发病率和死亡率.结果 2016年山西省肿瘤登记地区肝癌新发病例754例,发病率为15.42/10万(男性19.40/10万,女性11.29/10万),中标率和世标率分别为10.72/10万、10.75/10万;城市地区发病率为10.14/10万,中标率为6.73/10万;农村地区发病率为19.00/10万,中标率为13.48/10万.山西省肿瘤登记地区肝癌死亡病例761例,死亡率为15.56/10万(男性19.80/10万,女性11.17/10万),中标率和世标率分别为10.71/10万、10.86/10万.城市地区死亡率14.90/10万,中标率为9.86/10万,农村地区死亡率为16.01/10万,中标率为11.37/10万.肝癌发病率和死亡率均随年龄增加呈上升趋势,35岁以后发病率上升较为明显,全省发病率和死亡率分别在80岁和85岁年龄组达到高峰,男性高于女性.结论 山西省肿瘤登记地区肝癌发病率和死亡率均低于全国平均水平,男性发病率高于女性,农村地区发病率高于城市地区,应将男性及农村地区人群作为肝癌防治的重点对象.

BACKGROUND Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited. METHODS Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records. RESULTS In the full cohort of 8465 patients, the mean +/- SD age at diagnosis was 59.3 +/- 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan. CONCLUSIONS The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.

目的 山西省阳城县是全国恶性肿瘤高发地区之一,2006年起中央财政安排专项经费在阳城开展以内镜筛查技术为主的上消化道癌早诊早治项目.本研究采用山西阳城县上消化道癌早诊早治项目人群筛查队列数据,对其内镜筛查效果进行分析,为进一步做好农村上消化道癌早诊早治项目提供科学依据.方法 根据阳城县2006-2012年国家农村上消化道癌早诊早治项目工作流程要求,采取整群抽样方法,选取西河乡等7个乡镇的40～69岁年龄组作为目标人群,共计120066人,其中参加了项目集中宣教、登记等流程的53541人为干预组;因各种原因未参加任何筛查流程的66525人为对照组.干预组中12460人参与了癌症防治知识集中宣教、签署知情同意书、基本信息登记和流行病学调查、内镜筛查等完整的筛查流程,作为筛查组;41081人参加了筛查现场的癌症防治知识集中宣教、基本信息登记和流行病学调查等相关内容,但未参加内镜筛查,作为未筛查组.对筛查中发现的食管重度异型增生/原位癌和黏膜内癌、胃贲门高级别上皮内肿瘤采用内镜下早期治疗内镜黏膜切除术(endoscopic mucosal resection,EMR)、内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)等进行治疗,中晚期癌根据病情选择常规治疗手段.食管轻度异型增生每3年随访1次,中度异型增生、胃贲门低级别上皮内肿瘤每年随访1次.对其发病率和死亡率进行统计分析.结果 (1)干预组和对照组人群肿瘤发病情况比较:干预组全部恶性肿瘤累积发病率为701.53/10万人年,比对照组(811.95/10万人年)低15.74％,差异有统计学意义(RR=0.86,95％CI为0.82～0.91,P＜0.001);干预组上消化道癌发病率为386.59/10万人年,比对照组发病率(472.09/10万人年)低22.12％,差异有统计学意义(RR=0.82,95％CI为0.76～0.88,P＜0.001),干预组上消化道癌中食管癌、贲门癌和胃癌发病率均低于对照组,尤以食管癌最为明显.(2)干预组全部恶性肿瘤累积死亡率为269.38/10万人年,比对照组(337.81/10万人年)低25.40％,差异有统计学意义(RR=0.80,95％CI为0.73～0.87,P＜0.001);干预组上消化道癌死亡率为148.68/10万人年,比对照组死亡率(200.16/10万人年)低34.62％,差异有统计学意义(RR=0.74,95％CI为0.66～0.83,P＜0.001),干预组上消化道癌中食管癌、贲门癌和胃癌死亡率均低于对照组,尤以食管癌最为明显.结论 在农村上消化道癌高发区开展内镜筛查对降低上消化道癌发病率和死亡率均有效果,尤其对食管癌的发病和死亡效果明显.

Objective: To understand the health literacy of the cancer prevention and treatment among urban residents of China, and explore the related factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The health literacy of the cancer prevention, early discovery, early diagnosis, early treatment and the demands of cancer prevention and treatment knowledge was analyzed. The level of health literacy among different groups were calculated and compared. The binary logistic regression model was used to analyze the influencing factors of the health literacy of the cancer prevention and treatment. Results: The level of health literacy of the cancer prevention and treatment was 56.97% among all study population; in each group it was 55.01% for community residents, 59.08% for cancer risk assessment/screening population, 61.99% for cancer patients and 57.31% for occupational population, respectively (P<0.001). The level of health literacy of the cancer prevention and treatment of residents aged 50 to 69 years old, other occupational groups, unmarried, the central and western region residents and the group with unclear self-assessment of cancer risk was significantly lower than that of residents younger than 40 years old, personnel of public institutions/civil servants, married, the eastern region residents and the group whose self-assessment without cancer risk (P<0.05) . The level of health literacy of cancer prevention and treatment of females, people who went to high school or over, cancer risk assessment/screening population, cancer patients and occupational population was significantly higher than that of males, people who had an education level of primary school or below and community residents (P<0.05) . Conclusion: The health literacy of the cancer prevention and treatment of urban residents in China was relatively high, but there was still room for improvement. Gender, age, educational level, occupation, region, marital status, self-assessment of cancer risk, and type of respondents were the key influencing factors of the health literacy of the cancer prevention and treatment. Male, 50-69 years old, lower educational level, central and western regions, unclear cancer risk self-assessment, and without specific environmental exposure to cancer prevention and treatment knowledge or related risk factors were the characteristics of the key intervention group of the health literacy of the cancer prevention and treatment.目的： 了解我国城市居民肿瘤防治健康素养现况，并探讨其相关因素。 方法： 采用横断面调查的方法，于2015—2017年以2015年度城市癌症早诊早治项目覆盖的16个项目省份为研究现场，采用整群及方便抽样的方法，将年龄≥18岁、能够理解调查程序的居民纳入研究。共纳入32 257名研究对象，社区居民、癌症风险评估/筛查干预人群、现患癌症患者及职业人群分别有15 524、8 016、2 289、6 428名。对肿瘤预防、早发现、早诊断、早治疗、防治知识需求等态度和意识方面的健康素养情况进行分析；比较不同人群健康素养水平；采用多因素logistic回归模型分析居民肿瘤防治健康素养的影响因素。 结果： 我国城市居民的肿瘤防治健康素养水平为56.97%；社区居民、癌症风险评估/筛查干预人群、现患癌症患者和职业人群的肿瘤防治健康素养水平分别为55.01%、59.08%、61.99%、57.31%（P<0.001）。与≤39岁人群、事业单位人员/公务员、已婚、东部地区、自评无患癌风险人群相比，50~69岁、其他职业、非在婚、中西部地区、患癌风险自评不清楚者肿瘤防治健康素养水平较低（P<0.05）；与男性、小学及以下文化程度的人群及社区居民相比，女性、高中/中专以上文化程度人群、癌症风险评估/筛查干预人群、现患癌症患者和职业人群的肿瘤防治健康素养水平均较高（P<0.05）。 结论： 我国城市居民肿瘤防治意识角度的健康素养水平较高，但仍有可提升空间；性别、年龄、文化程度、职业、地区、婚姻状况、患癌风险自评、人群分类等是肿瘤防治健康素养的主要影响因素；男性、50~69岁、低文化程度、中西部地区、不清楚患癌风险、无特定环境接触肿瘤防治知识及相关危险因素的人群是肿瘤防治健康素养应重点干预的人群。.