背景:基于人群的食管癌(EC)筛查试验和项目已经在中国进行了数十年;然而,不同地区采用了筛查策略,筛查概况尚不清楚.
目的:我们进行了一项荟萃分析,以按阳性率,合规率,和内窥镜检查结果,旨在为EC筛查计划提供明确的证据和建议。
方法:English(PubMed,Embase)和中文(中国国家知识基础设施,Wanfang)的语言数据库进行了系统搜索,以在2022年12月31日之前在中国人群中进行基于人群的EC筛查研究。使用随机效应模型通过标准方法进行荟萃分析。计算三组的合并患病率:采用通用内窥镜检查策略的高危地区,中国农村采用风险分层内镜筛查(RSES)策略,和RSES战略的中国城市。阳性病例包括严重发育不良的病变,原位癌,粘膜内癌,粘膜下癌,和浸润性癌。
结果:中国农村高危人群的合并阳性率(44.12%)高于中国城市(23.11%)。我国农村内镜检查的达标率最高(52.40%),其次是高风险地区(50.11%),最低的是中国城市(23.67%)。阳性病例的合并检出率从高风险地区的1.03%(95%CI0.82%-1.30%)下降到中国农村的0.48%(95%CI0.25%-0.93%)和中国城市的0.12%(95%CI0.07%-0.21%)。低度上皮内瘤变(LGIN)的合并检出率也在同一顺序,在高风险地区最高(3.99%,95%CI2.78%-5.69%),其次是中国农村(2.55%,95%CI1.03%-6.19%)和中国城市(0.34%,95%CI0.14%-0.81%)。在男性中观察到阳性病例和LGIN的检出率高于女性和老年人。合并的早期检出率为81.90%(95%CI75.58%-86.88%),这与高风险地区的比率(82.09%)相似,在中国农村(80.76%),在中国城市(80.08%)。
结论:在目前的筛查框架下,高危地区的筛查获益高于其他地区.为了促进电子商务筛查,减少目前中国筛查的不平等,应更多关注优化高危个体评估和监测管理策略,以提高内镜检查的依从性.
背景:PROSPEROCRD42022375720;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=375720。
Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies have been adopted in different regions and screening profiles are unclear.
We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs.
English (PubMed, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until December 31, 2022. A meta-analysis was performed by standard methodology using a random-effects model. Pooled prevalence rates were calculated for three groups: high-risk areas with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy. Positive cases included lesions of severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, and invasive carcinoma.
The pooled positivity rate of the high-risk population was higher in rural China (44.12%) than in urban China (23.11%). The compliance rate of endoscopic examinations was the highest in rural China (52.40%), followed by high-risk areas (50.11%), and was the lowest in urban China (23.67%). The pooled detection rate of positive cases decreased from 1.03% (95% CI 0.82%-1.30%) in high-risk areas to 0.48% (95% CI 0.25%-0.93%) in rural China and 0.12% (95% CI 0.07%-0.21%) in urban China. The pooled detection rate of low-grade intraepithelial neoplasia (LGIN) was also in the same order, being the highest in high-risk areas (3.99%, 95% CI 2.78%-5.69%), followed by rural China (2.55%, 95% CI 1.03%-6.19%) and urban China (0.34%, 95% CI 0.14%-0.81%). Higher detection rates of positive cases and LGIN were observed among males than among females and at older ages. The pooled early detection rate was 81.90% (95% CI 75.58%-86.88%), which was similar to the rates in high-risk areas (82.09%), in rural China (80.76%), and in urban China (80.08%).
Under the current screening framework, a higher screening benefit was observed in high-risk areas than in other regions. To promote EC screening and reduce the current inequality of screening in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination.
PROSPERO CRD42022375720; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=375720.