Article(id=1320442639619572220, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442616123081022, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146661, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733932800000, receivedDateStr=2024-12-12, revisedDate=1744128000000, revisedDateStr=2025-04-09, acceptedDate=1754928000000, acceptedDateStr=2025-08-12, onlineDate=1792747657922, onlineDateStr=2026-10-23, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792747657922, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792747657922, creator=13701087609, updateTime=1792747657922, updator=13701087609, issue=Issue{id=1320442616123081022, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='1', pageStart='1', pageEnd='128', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792747652321, creator='13701087609', updateTime=1792748136930, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444648791851086, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442616123081022, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444648791851087, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442616123081022, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=71, endPage=75, ext={EN=ArticleExt(id=1320442639820898813, articleId=1320442639619572220, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Colorectal cancer in urban residents of Xuzhou from 2014 to 2021: a screening and follow-up study, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the screening and follow-up results for colorectal cancer (CRC) among urban residents in Xuzhou city, Jiangsu province from 2014 to 2021, thereby providing evidence for optimizing local CRC screening strategies.

Methods

From July 2014 to December 2021, a randomized cluster sampling method was used to select 521 799 urban residents aged 40–74 years from 44 communities (8 in Gulou district, 5 in Yunlong district, 15 in Quanshan district, 5 in Jiawang district, and 11 in Tongshan district) in Xuzhou city. A risk assessment questionnaire was administered to identify high-risk populations for CRC, followed by clinical screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were analyzed. All participants in the questionnaire survey underwent regular follow-up, with detailed documentation of outcomes.

Results

From 2014 to 2021, a total of 118 012 urban residents in Xuzhou completed the questionnaire, with 15 444 high-risk individuals (high-risk rate: 13.09%) being identified. Among the high-risk group, 4 070 underwent colonoscopy (compliance rate: 26.35%). Colonoscopy detected non-neoplastic polyps (1 096 cases), non-advanced adenomas (812 cases), advanced adenomas (191 cases), and CRC (5 cases), which showed the detection rates of 26.93%, 19.95%, 4.69%, and 0.12%, respectively. The early diagnosis rate was 85.46% (194/227). By December 31, 2023, the median follow-up time was 6.1 years, with 458 reported CRC cases (cumulative incidence: 0.39%) and 107 CRC deaths (cumulative mortality: 0.09%). Among confirmed cases with TNM staging (280 cases, 61.14% of total new cases), the proportion of early-stage cancer was higher in the high-risk group (62.79%) than in the non-high-risk group (44.73%) (χ2 = 4.76, P = 0.029).

Conclusions

From 2014 to 2021 in Xuzhou, colonoscopy compliance and CRC detection rates remained low among high-risk urban populations. The high-risk group exhibited a higher proportion of early-stage cancer than the non-high-risk group, which suggested that CRC screening in high-risk populations can improve the early diagnosis rate.

, authors=De LIU1, Cheng QIAO1, Ting LI1, Zongmei DONG1, Peipei CHEN1, Yunxin KONG2, Dong DONG2, Pan ZHANG1, authorsList=De LIU, Cheng QIAO, Ting LI, Zongmei DONG, Peipei CHEN, Yunxin KONG, Dong DONG, Pan ZHANG, authorCompany=null, correspAuthors=Pan ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Pan, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1320442640076751358, articleId=1320442639619572220, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=2014—2021年徐州市城市居民结直肠癌筛查和随访分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

分析2014―2021年江苏省徐州市城市居民结直肠癌(CRC)筛查和随访结果,为当地结直肠癌筛查策略的优化提供参考依据。

方法

于2014年7月—2021年12月,采用随机整群抽样方法,抽取徐州市鼓楼区8个社区、云龙区5个社区、泉山区15个社区、贾汪区5个社区和铜山区11个社区共44个社区的521 799名40~74岁城市居民进行风险评估问卷调查。评估出结直肠癌的高危人群进行结直肠癌临床筛查。分析该地区城市居民结直肠癌的高危率、结肠镜检查依从率和病变检出率,并对所有参与风险评估问卷调查者进行定期随访,详细记录随访结局。

结果

2014—2021年,徐州市共完成118 012名城市居民的问卷评估,评估出结直肠癌高危人群15 444人,高危率为13.09%;评估的结直肠癌高危人群中接受肠镜检查者4 070人,肠镜检查依从率为26.35%;结肠镜检查者中检出非瘤性息肉1 096例、非进展期腺瘤812例、进展期腺瘤191例和结直肠癌5例,检出率分别为26.93%、19.95%、4.69%和0.12%,早诊率为85.46%(194/227)。截至2023年12月31日,中位随访时间为6.1年,共报告结直肠癌发病458例,累积发病率为0.39%;报告结直肠癌死亡107例,累积死亡率为0.09%;经病理确诊有明确肿瘤分期(TNM)的共280例,占全部新发结直肠癌病例的61.14%;高危组早期癌比例(62.79%)高于非高危组早期癌比例(44.73%),差异有统计学意义(χ2=4.76,P=0.029)。

结论

2014—2021年徐州市城市居民结直肠癌高危人群肠镜检查依从率和结直肠癌检出率均较低;高危组早期癌比例高于非高危组,在高危人群中进行结直肠癌筛查可以提高早诊率。

, authors=刘德1, 乔程1, 李婷1, 董宗美1, 陈培培1, 孔蕴馨2, 董栋2, 张盼1, *, *, authorsList=刘德, 乔程, 李婷, 董宗美, 陈培培, 孔蕴馨, 董栋, 张盼, authorCompany=null, correspAuthors=张盼, authorNote=

刘德(1988—),主管医师,硕士,研究方向:肿瘤防制

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张盼,E-mail:
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Colonoscopy results of the urban high-risk population for colorectal cancer in Xuzhou city, 2014–2021

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特征分类非瘤性息肉非进展期腺瘤进展期腺瘤结直肠癌
检出数/例检出率/%检出数/例检出率/%检出数/例检出率/%检出数/例检出率/%
性别男性64433.3548725.221326.8440.21
女性45221.13 b32515.19 b592.76 b10.05 c
年龄/岁40~4914820.1612216.62121.6300.00
50~5945025.6331718.05663.7600.00
60~6942931.1832623.69916.6120.15
70~746933.82 b4723.04 b2210.78 b31.47 ac
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2014—2021年徐州市城市结直肠高危人群结肠镜检查结果

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特征分类非瘤性息肉非进展期腺瘤进展期腺瘤结直肠癌
检出数/例检出率/%检出数/例检出率/%检出数/例检出率/%检出数/例检出率/%
性别男性64433.3548725.221326.8440.21
女性45221.13 b32515.19 b592.76 b10.05 c
年龄/岁40~4914820.1612216.62121.6300.00
50~5945025.6331718.05663.7600.00
60~6942931.1832623.69916.6120.15
70~746933.82 b4723.04 b2210.78 b31.47 ac
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2014—2021年徐州市城市居民结直肠癌筛查和随访分析
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刘德 1 , 乔程 1 , 李婷 1 , 董宗美 1 , 陈培培 1 , 孔蕴馨 2 , 董栋 2 , 张盼 1, *, *
中国公共卫生 | 调查报告与分析 2026,42(1): 71-75
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中国公共卫生 |调查报告与分析 2026 , 42 (1) : 71 -75
2014—2021年徐州市城市居民结直肠癌筛查和随访分析
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刘德1, 乔程1, 李婷1, 董宗美1, 陈培培1, 孔蕴馨2, 董栋2, 张盼1, *, *
作者信息
  • 1徐州市疾病预防控制中心,徐州 221000
  • 2徐州市肿瘤医院,徐州 221005
通讯作者:
张盼,E-mail:
作者简介:

刘德(1988—),主管医师,硕士,研究方向:肿瘤防制

Colorectal cancer in urban residents of Xuzhou from 2014 to 2021: a screening and follow-up study
De LIU1, Cheng QIAO1, Ting LI1, Zongmei DONG1, Peipei CHEN1, Yunxin KONG2, Dong DONG2, Pan ZHANG1
Affiliations
  • 1Xuzhou Center for Disease Control and Prevention, Xuzhou 221000, China
  • 2Xuzhou Cancer Hospital, Xuzhou 221005, China
  • Corresponding Author:
    ZHANG Pan, E-mail:
出版时间: 2026-01-10 doi: 10.11847/zgggws1146661
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目的

分析2014―2021年江苏省徐州市城市居民结直肠癌(CRC)筛查和随访结果,为当地结直肠癌筛查策略的优化提供参考依据。

方法

于2014年7月—2021年12月,采用随机整群抽样方法,抽取徐州市鼓楼区8个社区、云龙区5个社区、泉山区15个社区、贾汪区5个社区和铜山区11个社区共44个社区的521 799名40~74岁城市居民进行风险评估问卷调查。评估出结直肠癌的高危人群进行结直肠癌临床筛查。分析该地区城市居民结直肠癌的高危率、结肠镜检查依从率和病变检出率,并对所有参与风险评估问卷调查者进行定期随访,详细记录随访结局。

结果

2014—2021年,徐州市共完成118 012名城市居民的问卷评估,评估出结直肠癌高危人群15 444人,高危率为13.09%;评估的结直肠癌高危人群中接受肠镜检查者4 070人,肠镜检查依从率为26.35%;结肠镜检查者中检出非瘤性息肉1 096例、非进展期腺瘤812例、进展期腺瘤191例和结直肠癌5例,检出率分别为26.93%、19.95%、4.69%和0.12%,早诊率为85.46%(194/227)。截至2023年12月31日,中位随访时间为6.1年,共报告结直肠癌发病458例,累积发病率为0.39%;报告结直肠癌死亡107例,累积死亡率为0.09%;经病理确诊有明确肿瘤分期(TNM)的共280例,占全部新发结直肠癌病例的61.14%;高危组早期癌比例(62.79%)高于非高危组早期癌比例(44.73%),差异有统计学意义(χ2=4.76,P=0.029)。

结论

2014—2021年徐州市城市居民结直肠癌高危人群肠镜检查依从率和结直肠癌检出率均较低;高危组早期癌比例高于非高危组,在高危人群中进行结直肠癌筛查可以提高早诊率。

结直肠癌(CRC)  /  筛查  /  随访  /  城市居民  /  风险评估  /  结肠镜  /  徐州市
Objective

To analyze the screening and follow-up results for colorectal cancer (CRC) among urban residents in Xuzhou city, Jiangsu province from 2014 to 2021, thereby providing evidence for optimizing local CRC screening strategies.

Methods

From July 2014 to December 2021, a randomized cluster sampling method was used to select 521 799 urban residents aged 40–74 years from 44 communities (8 in Gulou district, 5 in Yunlong district, 15 in Quanshan district, 5 in Jiawang district, and 11 in Tongshan district) in Xuzhou city. A risk assessment questionnaire was administered to identify high-risk populations for CRC, followed by clinical screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were analyzed. All participants in the questionnaire survey underwent regular follow-up, with detailed documentation of outcomes.

Results

From 2014 to 2021, a total of 118 012 urban residents in Xuzhou completed the questionnaire, with 15 444 high-risk individuals (high-risk rate: 13.09%) being identified. Among the high-risk group, 4 070 underwent colonoscopy (compliance rate: 26.35%). Colonoscopy detected non-neoplastic polyps (1 096 cases), non-advanced adenomas (812 cases), advanced adenomas (191 cases), and CRC (5 cases), which showed the detection rates of 26.93%, 19.95%, 4.69%, and 0.12%, respectively. The early diagnosis rate was 85.46% (194/227). By December 31, 2023, the median follow-up time was 6.1 years, with 458 reported CRC cases (cumulative incidence: 0.39%) and 107 CRC deaths (cumulative mortality: 0.09%). Among confirmed cases with TNM staging (280 cases, 61.14% of total new cases), the proportion of early-stage cancer was higher in the high-risk group (62.79%) than in the non-high-risk group (44.73%) (χ2 = 4.76, P = 0.029).

Conclusions

From 2014 to 2021 in Xuzhou, colonoscopy compliance and CRC detection rates remained low among high-risk urban populations. The high-risk group exhibited a higher proportion of early-stage cancer than the non-high-risk group, which suggested that CRC screening in high-risk populations can improve the early diagnosis rate.

colorectal cancer  /  screening  /  follow-up  /  urban residents  /  risk assessment  /  colonoscopy  /  Xuzhou city
刘德, 乔程, 李婷, 董宗美, 陈培培, 孔蕴馨, 董栋, 张盼. 2014—2021年徐州市城市居民结直肠癌筛查和随访分析. 中国公共卫生, 2026 , 42 (1) : 71 -75 . DOI: 10.11847/zgggws1146661
De LIU, Cheng QIAO, Ting LI, Zongmei DONG, Peipei CHEN, Yunxin KONG, Dong DONG, Pan ZHANG. Colorectal cancer in urban residents of Xuzhou from 2014 to 2021: a screening and follow-up study[J]. Chinese Journal of Public Health, 2026 , 42 (1) : 71 -75 . DOI: 10.11847/zgggws1146661
结直肠癌是全球常见的恶性肿瘤之一。据估计,2022年全球新发结直肠癌192.61万例,占全部新发肿瘤的9.65%;死亡90.39万例,占全部死亡肿瘤的9.28%;结直肠癌发病和死亡分别居全球肿瘤发病和死亡的第3位和第2位[1]。2022年中国结直肠癌新发病例为51.71万例,占全球结直肠癌新发病例的26.85%;结直肠癌死亡病例为24.00万例,占全球结直肠癌死亡病例的26.55%[2]。近30年来,我国结直肠癌发病率和死亡率均呈上升趋势[3–4],面临的结直肠癌疾病负担日益沉重。研究表明,结直肠癌筛查可有效降低结直肠癌的发病率和死亡率。得益于结直肠癌筛查的实施,近年来,美国和部分欧洲国家结直肠癌发病率和死亡率已呈现下降趋势[5–7]。相比之下,我国结直肠癌筛查工作起步较晚,2012年“城市癌症早诊早治项目”才正式纳入国家重大公共卫生专项,对公众免费提供包括结直肠癌在内的5种常见癌症的筛查服务。江苏省徐州市2014年作为项目点开展城市癌症早诊早治项目工作。为分析徐州市2014—2021年城市居民结直肠癌筛查和随访结果,为当地结直肠癌筛查策略的优化提供参考依据,本研究于2014年7月—2021年12月,采用随机整群抽样方法,抽取徐州市鼓楼区8个社区、云龙区5个社区、泉山区15个社区、贾汪区5个社区和铜山区11个社区共44个社区的521 799名40~74岁城市居民进行风险评估问卷调查。评估出结直肠癌的高危人群进行结直肠癌临床筛查,分析该地区城市居民结直肠癌的高危率、肠镜检查依从率和病变检出率。并对所有参与风险评估问卷调查者进行定期随访,详细记录随访结局。结果报告如下。
采用随机整群抽样方法,抽取徐州市鼓楼区8个社区、云龙区5个社区、泉山区15个社区、贾汪区5个社区和铜山区11个社区共44个社区的521 799名40~74岁城市居民进行风险评估问卷调查。筛查对象为本市户籍或居住在该地区≥1年的常住居民。2014—2016年纳入年龄为40~69岁、2017—2018年纳入年龄为40~74岁、2019—2021年纳入年龄为45~74岁。排除已确诊为结直肠癌患者和患有严重心、脑、肺、肾功能障碍或精神病患者以及无法配合完成问卷调查者。本研究经徐州市肿瘤医院伦理委员会审查批准(批号:2023-02-030-K01)。所有筛查对象均签署知情同意书。
按照国家癌症中心制定的《城市癌症早诊早治项目技术方案》[8]要求,对筛查人群进行防癌风险评估问卷调查。内容包括:基本信息(性别、年龄、身高、体重、腰围、婚姻状况和职业等);饮食习惯(新鲜蔬菜、水果、畜肉、粗粮和腌晒食品摄入情况);生活方式(吸烟、饮酒和锻炼情况)以及恶性肿瘤家族史等。由经过统一培训的调查员进行面访调查。其中,吸烟指吸烟平均≥1支/天且连续或累计≥6个月[9];饮酒指平均饮酒≥1次/周且连续≥6个月[9];体育锻炼指进行体育锻炼或累计≥3次/周且或累计≥30分/次[9]。
调查问卷经质控评估后录入国家癌症中心开发的高危人群评估系统。该系统以“哈佛癌症风险指数”理论为基础,通过专家共识对我国成年人癌症发病的主要危险因素进行赋值,对参与个体进行癌症高危评估[8]。根据评估结果要求结直肠癌高危者,在规定时间内到徐州市肿瘤医院进行结直肠癌临床筛查。
问卷调查后评估为结直肠癌高风险人群至指定医院进行免费结肠镜检查。结肠镜操作者由具有主治医师及以上职称且工作满5年的医务工作人员担任。结直肠相关病变检出情况主要包括:(1)非瘤性息肉:指结直肠黏膜表面异常生长的肿物,包括增生性息肉、炎性息肉等;(2)进展期腺瘤:指某些具有癌变潜能的良性病变,即癌前病变,包括锯齿状腺瘤、绒毛状腺瘤、腺瘤(≥1 cm)及高级别上皮内瘤变;(3)非进展期腺瘤:除进展期腺瘤以外的腺瘤;(4)结直肠癌:病理诊断为结直肠癌者,包含早期癌(TNM分期T1-2N0M0的癌)[10–11]。
本研究对所有参加风险评估问卷调查者进行主动随访和被动随访。随访时间截至2023年12月31日,详细记录被随访者的人口学资料和诊疗信息。其中,主动随访包括入户访谈、电话询问和临床筛查单位随访等;被动随访使用徐州市肿瘤信息化系统、全死因数据库和医院病案管理信息系统平台,通过身份证号码进行匹配。对未匹配到结局的患者使用姓名、性别和出生日期3个字段进行再次匹配。同时人工复核判断是否为同一调查者。
应用SPSS 17.0统计软件建立数据库进行一般描述性分析、χ2检验和Fisher确切概率法检验。以P<0.05为差异有统计学意义。结直肠癌高危率=(评估为结直肠癌高危例数/问卷调查例数)×100%;结肠镜检查依从率=(完成结肠镜检查例数/评估为结直肠癌高危例数)×100%;早诊率=[锯齿状腺瘤+绒毛状腺瘤+腺瘤(≥1 cm)+高级别上皮内瘤变+早期癌]/[锯齿状腺瘤+绒毛状腺瘤+腺瘤(≥1 cm)+高级别上皮内瘤变+癌+其他罕见肿瘤];结直肠病变检出率=(检出结直肠相关病变例数/完成结肠镜检查例数)×100%。
2014—2021年徐州市参与结直肠癌风险评估问卷调查的118 012名居民中,男性52 016人(44.08%),女性65 996人(55.92%);年龄40~49岁27 561人(23.35%),50~59岁41 158人(34.88%),60~69岁38 425人(32.56%),70~74岁10 868人(9.21%)。
2014—2021年徐州市参与结直肠癌风险评估问卷调查的118 012名居民中,评估出结直肠癌高危人群15 444人,高危率为13.09%。男性和女性居民结直肠癌高危率分别为17.05%(8867/52 016)和9.97%(6577/65 996);40~49岁、50~59岁、60~69岁和70~74岁居民结直肠癌高危率分别为8.98%(2 474/27 561)、12.84%(5283/41 158)、14.71%(5653/38 425)和18.72%(2034/10 868);不同特征参与结直肠癌风险评估问卷调查居民比较,不同性别和年龄居民结直肠癌高危率不同,差异均有统计学意义(χ2=1 282.30和803.60,均P<0.001)。
2014—2021年徐州市结直肠癌风险评估问卷评估出的15444名高危人群中,参与结肠镜检查者4 070人,结肠镜检查依从率为26.35%;男性和女性结直肠癌高危人群的结肠镜检查依从率分别为21.78%(1931/8867)和32.52%(2 139/6577),40~49岁、50~59岁、60~69岁和70~74岁居民结直肠癌高危率分别为29.67%(734/2 474)、33.24%(1 756/5283)、24.34%(1 376/5653)和10.03%(204/2 034);不同特征结直肠癌高危人群比较,不同性别和年龄结直肠癌高危人群结肠镜检查依从率不同,差异均有统计学意义(χ2=224.63和434.11,均P<0.001)。
2014—2021年徐州市参与结肠镜检查的4 070名结直肠癌高危人群中,检出非瘤性息肉1 096例、非进展期腺瘤812例、进展期腺瘤191例和结直肠癌5例,检出率分别为26.93%、19.95%、4.69%和0.12%;早诊率为85.46%(194/227)。不同特征结直肠癌高危人群比较,不同性别结直肠癌高危人群非瘤性息肉、非进展期腺瘤和进展期腺瘤检出率不同,不同年龄结直肠癌高危人群非瘤性息肉、非进展期腺瘤、进展期腺瘤和结直肠癌检出率不同,差异均有统计学意义(均P<0.01)。
采用主动随访与被动随访相结合的方式对所有参与问卷评估的城市居民进行随访。截至2023年12月31日,中位随访时间为6.1年,共报告结直肠癌发病458例和死亡107例,累积发病率和累积死亡率分别为0.39%和0.09%。高危组和非高危组人群结直肠癌累积发病率分别为0.43%(66/15444)和0.38%(392/102 568),累积死亡率分别为0.09%(11/15444)和0.07%(96/102 568),2组人群结直肠癌累积发病率和累积死亡率差异均无统计学意义(均P>0.05)。结肠镜检查组和非结肠镜检查组人群结直肠癌累积发病率分别为0.29%(12/4070)和0.47%(54/11 374),累积死亡率分别为0.02%(1/4070)和0.09%(10/11 374),2组人群结直肠癌累积发病率和累积死亡率差异均无统计学意义(均P>0.05)。经病理确诊有明确TNM分期者共280例,占全部结直肠癌新发病例的61.14%;高危组和非高危组人群早期癌比例分别为62.79%(27/43)和44.73%(106/237),高危组早期癌比例高于非高危组人群,差异有统计学意义(χ2=4.76,P=0.029);结肠镜筛查组和非结肠镜筛查组人群早期癌比例分别为75.00%(6/8)和57.14%(20/35),2组人群早期癌比例差异无统计学意义(P>0.05)。
全球疾病负担研究(Global Burden of Disease, GBD)结果显示,2021年全球结直肠癌导致的伤残调整寿命年(Disability-Adjusted Life Years, DALY)高达2 440.11万人年[12]。有研究预测,如果按照最新发病率趋势持续下去,2070年全球结直肠癌发病数将达到470万例,在所有癌症发病数中居第1位[13]。因此,如何应对结直肠癌的高流行态势将成为未来公共卫生领域思考的主要问题,在全球范围内推广结直肠癌筛查显得尤为重要。
本研究结果显示,2014—2021年徐州市城市居民结直肠癌的高危率为13.09%,高于山东省青岛市(10.25%)[10]和重庆市(12.60%)[14],低于河北省(21.46%)[15]、辽宁省沈阳市(24.60%)[16]和江西省南昌市(26.02%)[17];与浙江省(13.20%)[18]相近。男性居民高危率(17.05%)高于女性居民(9.97%),差异有统计学意义(χ2=1 282.30,P<0.001),与河北省[15]和江西省南昌市[17]研究结果一致。这可能与男性居民吸烟和饮酒等不健康生活方式和肥胖率更高有关。有流行病学数据显示,吸烟、饮酒和肥胖等均会增加结直肠癌的发病风险[19–20]。
本研究中,2014—2021年徐州市城市结直肠癌高危人群结肠镜检查依从率为26.35%,高于山东省青岛市(25.85%)[10]、重庆市(18.89%)[14]和河北省(21.10%)[15];低于江西省南昌市(33.73%)[17]和广东省深圳市(41.88%)[21];与湖南省(27.15%)[22]相近。女性高危人群结肠镜检查依从率(32.52%)高于男性高危人群(21.78%),各年龄组中,70~74岁高危人群结肠镜检查的依从率最低(10.03%)。2018年,美国结直肠癌筛查结肠镜检查依从率为66.9%[23]。相比之下,我国结肠镜检查的依从率较低,全国平均水平仅为17.25%[24]。究其原因:一方面,结肠镜检查是一种侵入性操作,与非侵入性检查相比,居民接受度较低;另一方面,结肠镜检查需要充分的肠道准备。有研究表明,对肠道准备的恐惧是很多人拒绝结肠镜检查的主要原因[25],这种恐惧主要来自肠道准备制剂的味道、充分结肠准备所需的泻剂体积以及肠道准备过程中缺乏标准化的指导。同时这些因素也会导致清肠效果不理想。Sharara A I等[26]研究表明,肠道准备不足可能导致腺瘤和锯齿状息肉等病变的漏诊,从而增加结肠镜检查后结肠癌的发病风险。提示在今后的筛查工作中,应加强男性和高龄老年人群对结肠镜检查重要性的认识,优化筛查流程,制定标准化的肠道准备指导,从而缓解其对肠道准备的恐惧心理,不断提高结肠镜检查的依从性。
本研究结果显示,2014—2021年徐州市城市结直肠癌高危人群的结直肠癌检出率为0.12%,低于山东省青岛市(0.29%)[10]、河北省(0.45%)[15]、辽宁省沈阳市(0.21%)[16]和深圳市(0.22%)[21];与重庆市(0.16%)[14]相近。本研究中,非瘤性息肉、非进展期腺瘤和进展期腺瘤检出率分别为26.93%、19.95%和4.69%,男性检出率均高于女性;且各年龄组检出率均不同,与杜佳等[14]研究结果类似。各地区结直肠病变检出率不同,除了与不同地区高发癌种和当地医疗水平不同有关外,还可能与结肠镜操作医师的诊疗水平有关。一项多中心随机对照试验研究结果显示,腺瘤检出率最高的结肠镜医师组与腺瘤检出率最低的结肠镜医师组相比,进行结肠镜检查的患者偶发性癌症的风险降低48%,而致死性结直肠癌的风险则降低62%[27]。提示相关部门应加强对结肠镜操作医师的规范化、同质化培训,进一步提高结直肠病变的检出率。
结肠镜检查是检查结直肠病变(包括癌前病变和癌性病变)的金标准。研究表明,与未接受结肠镜检查者相比,结肠镜检查者的结直肠癌发病率降低约40%,死亡率则降低约60%[28]。本研究随访结果显示,结肠镜筛查组人群结直肠癌发病率和死亡率均略低于非结肠镜筛查组人群,但差异均无统计学意义,与上述研究结果不同。这可能有多方面原因:首先,本研究的中位随访时间为6.1年,相较于结直肠癌发生发展的长期过程而言,此时间跨度相对较短,可能难以反映出筛查效果的长期累积效应。加之本研究中通过筛查发现5例结直肠癌新发病例,短时间内提高了筛查组发病率,从而缩小了2组人群发病率的差异;其次,本研究中筛查组样本量相对较小,代表性受到一定影响,这可能掩盖了结肠镜检查本身的积极效果。值得注意的是,当前国内同类研究多聚焦于横断面数据的初步分析,针对死亡率等长期健康结局指标的深入探讨较少。提示在今后的研究中亟需开展大规模、长周期的随机对照研究,进一步验证结直肠癌筛查的实际效果和长期价值。
早期癌症的发现对于提高癌症生存率具有重要意义。有研究表明,Ⅰ期结直肠癌患者的5年相对生存率为91%,而发生远处转移Ⅳ期结直肠癌患者的5年相对生存率仅为14%[29]。本研究结果显示,2014—2021年徐州市城市居民结直肠癌的早诊率为85.46%,低于山东省青岛市(99.75%)[10],与天津市(86.27%)[11]相近。达到了发现早期病变的目的。且随访结果显示,高危组人群早期癌比例高于非高危组人群,提示基于“哈佛癌症风险指数”为理论基础的高危人群评估模型在我国癌症筛查资源相对不充足的情况下,通过问卷评估识别高危人群并开展结直肠癌筛查可以提高结直肠癌的早诊率。
综上所述,2014—2021年徐州市城市结直肠癌高危人群肠镜检查依从率和结直肠癌检出率均较低。高危组早期癌比例高于非高危组,在高危人群中进行结直肠癌筛查可以提高早诊率。本研究的优势在于通过对2014—2021年徐州市城市癌症早诊早治项目的参与者进行定期随访,详细收集包括TNM分期在内的结局信息,为评估结直肠癌筛查的有效性提供了数据支持。本研究仍然存在一定的局限性:首先,结直肠癌检出率较低,可能与操作医师的技术水平有关,不排除漏诊的可能;其次,部分居民为参加免费筛查,问卷填写过程中可能存在夸大疾病事实的情况,虽然经过多级质控,但仍可能存在信息偏倚。因此,在今后的工作中应加大癌症早诊早治的科普宣传力度,优化筛查流程;同时加强对结肠镜操作医师的规范化、同质化培训,不断提升早诊早治项目筛查效果,降低居民的结直肠癌疾病负担。

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2026年第42卷第1期
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doi: 10.11847/zgggws1146661
  • 接收时间:2024-12-12
  • 首发时间:2026-10-23
  • 出版时间:2026-01-10
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  • 收稿日期:2024-12-12
  • 修回日期:2025-04-09
  • 录用日期:2025-08-12
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    1徐州市疾病预防控制中心,徐州 221000
    2徐州市肿瘤医院,徐州 221005

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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