上海市结直肠癌筛查项目参与状态对结直肠癌发病、分期及患者生存结局的影响

彭鹏; 窦剑明; 吴春晓; 庞怡; 龚杨明; 吴梦吟; 施燕; 顾凯

doi:10.19401/j.cnki.1007-3639.2025.07.004

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上海市结直肠癌筛查项目参与状态对结直肠癌发病、分期及患者生存结局的影响

专题论著 | 更新时间：2025-12-31

- 上海市结直肠癌筛查项目参与状态对结直肠癌发病、分期及患者生存结局的影响
- The impact of participation status on the colorectal cancer incidence, stage and survival outcomes in the Shanghai colorectal cancer screening program
- 中国癌症杂志 2025年35卷第7期页码：657-664
- 作者机构：
  
  上海市疾病预防控制中心慢性非传染性疾病与伤害防治所，上海 201107
- 作者简介：
  
  [ "彭鹏（ORCID: 0009-0005-3968-5179），学士，副主任医师。" ]
  [ "顾凯，主任医师，上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科主任。上海市抗癌协会常务理事，上海市抗癌协会儿童肿瘤专业委员会副主任委员，上海市优生优育科学协会阴道镜和宫颈病理专业委员会副主任委员，上海市抗癌协会胃肠肿瘤专业委员会常务委员，上海市医学会肿瘤专科分会委员。长期从事肿瘤登记报告和癌症筛查管理工作，承担多项国家和上海市癌症筛查项目实施和评价，在癌症预防领域有着丰富的经验。" ]
- 基金信息：
  
  国家科技重大专项慢性非传染性疾病(2024ZD0524200)
- DOI：10.19401/j.cnki.1007-3639.2025.07.004
  中图分类号： R735.3+5；R735.3+7
- 收稿：2025-07-08，
  
  修回：2025-07-15，
  
  纸质出版：2025-07-30
- 稿件说明：
移动端阅览
彭鹏, 窦剑明, 吴春晓, 等. 上海市结直肠癌筛查项目参与状态对结直肠癌发病、分期及患者生存结局的影响[J]. 中国癌症杂志, 2025,35(7):657-664.

Peng PENG, Jianming DOU, Chunxiao WU, et al. The impact of participation status on the colorectal cancer incidence, stage and survival outcomes in the Shanghai colorectal cancer screening program[J]. China Oncology, 2025, 35(7): 657-664.
彭鹏, 窦剑明, 吴春晓, 等. 上海市结直肠癌筛查项目参与状态对结直肠癌发病、分期及患者生存结局的影响[J]. 中国癌症杂志, 2025,35(7):657-664. DOI： 10.19401/j.cnki.1007-3639.2025.07.004.

Peng PENG, Jianming DOU, Chunxiao WU, et al. The impact of participation status on the colorectal cancer incidence, stage and survival outcomes in the Shanghai colorectal cancer screening program[J]. China Oncology, 2025, 35(7): 657-664. DOI： 10.19401/j.cnki.1007-3639.2025.07.004.

摘要

背景与目的：

上海市社区居民结直肠癌筛查项目从2013年开始实施至今已12年。本研究旨在以筛查参与状态分组，分析筛查对结直肠癌发病、分期及生存结局的影响。

方法：

采用基于注册的队列研究方法，将2013—2017年上海市户籍居民中符合筛查年龄范围的人群分为筛查组和非筛查组，通过肿瘤登记报告系统收集入组后5年期间诊断为结直肠癌的病例，按性别、年龄和诊断年份等分类计算结直肠癌年龄标准化累积发病率和年龄组累积发病率、诊断时分期及生存率。使用Joinpoint回归分析方法计算年度变化百分比进行累积发病率趋势分析，采用寿命表法和EdererⅡ法计算结直肠癌患者的5年观察生存率和期望生存率，最终获得相对生存率。

结果：

分别纳入50~74岁筛查组对象1 687 689人和非筛查组对象4 713 307人，随访5年期间两组分别新发结直肠癌病例10 333例和20 904例。筛查组年龄标准化5年累积发病率为555.33/10万，平均每年增长33.32%（

0.05），非筛查组年龄标准化5年累积发病率为529.85/10万，平均每年增长48.13%（

0.05）。筛查组与非筛查组年龄标准化5年累积发病率差异无统计学意义（

=0.25，

=0.804）；年龄组越低，筛查组年龄标准化累积发病率年度变化百分比增长与非筛查组相比差异越大。筛查组和非筛查组新发结直肠癌病例诊断时0~Ⅰ期分别占14.70%和7.46%，两组构成差异有统计学意义（

0.05）。筛查组患者5年相对生存率为73.94%，显著高于非筛查组（59.66%），差异有统计学意义（

0.05）。两组病例的女性生存率均高于男性，生存率随诊断时年龄增加而降低。

结论：

居民结直肠癌筛查项目实施，筛查参与人群的结直肠癌发病率增长速度得到遏制，结直肠癌病例诊断时早期比例和5年生存率均得到显著提升。要实现全人群结直肠癌发病率下降，需大力提高适宜人群筛查覆盖率，特别是促进低年龄组人群参与筛查的比例；应关注高年龄组筛查质量，提高高风险人群肠镜检查的依从性。同时进一步优化不同性别、年龄和风险人群筛查的精细化管理。

Abstract

Background and purpose:

The colorectal cancer screening program for community residents in Shanghai has been implemented for 12 years since 2013. This study aimed to analyze the impact of screening on the colorectal cancer incidence

stage and survival outcomes based on their screening participation status.

Methods:

This study used registry-based cohort study method. The registered residents in Shanghai from 2013 to 2017 who met the screening age range were divided into screening group and non-screening group. The data of colorectal cancer cases after being included in groups were obtained from the Population Based Cancer Registry. We calculated age-standardized cumulative incidence and age-group cumulative incidence

diagnosis stage and survival rate of colorectal cancer by gender

age and year of diagnosis. We used the Joinpoint regression method to calculate the annual change percentage for cumulative incidence trend analysis. The life table method and EdererⅡ method were used to calculate the 5-year observed survival rates and expected survival rates of colorectal cancer cases. Finally the 5-year relative survival rates were obtained.

Results:

The study included 1 687 689 participants aged 50-74 in screening group and 4 713 307 participants in non-screening group. During a 5-year follow-up period

there were 10 333 and 20 904 new cases of colorectal cancer diagnosed in the two groups

respectively. The age-standardized 5-year cumulative incidence in the screening group was 555.33/10

with an average annual increase of 33.32% (

0.05). The age-standardized 5-year cumulative incidence in the non-screening group was 529.85/10

with an average annual increase of 48.13% (

0.05). There was no statistically significant difference between the screening group and the non-screening group in the age-standardized 5-year cumulative incidence (

=0.25

=0.804). The lower the age group

the greater the difference between the screening group and the non-screening group in the annual average change percentage of the age-standardized cumulative incidence. The stages 0-Ⅰ of newly diagnosed colorectal cancer cases in the screening group and non-screening group accounted for 14.70% and 7.46%

respectively

with a statistically significant difference in composition between the two groups (

0.05). The 5-year relative survival rate of the screening group was 73.94%

while the non-screening group was 59.66%. The survival rate indicators of the former were significantly higher than those of the latter

and the difference was statistically significant. The survival rate of the former was significantly higher than that of the latter (73.94%

59.66%)

and the difference was statistically significant (

0.05). The survival rate of females in both groups of cases was higher than that of males

and the survival rate decreased with increasing age-groups at diagnosis.

Conclusion:

With the implementation of the colorectal cancer screening program

the growth trend of the incidence rate of colorectal cancer among the screening participants has been curbed

and the early stages of colorectal cancer cases diagnosed and the 5-year survival rate were significantly improved. In order to reduce the incidence rate of colorectal cancer in the whole population

it is necessary to vigorously promote the screening coverage of the appropriate population

especially to increase the proportion of lower age groups participating in screening. We should also pay attention to the screening quality of the elderly groups and improve the compliance o

f colonoscopy in high-risk participants. At the same time

we should further optimize the refined management of screening for different genders

ages

and risk groups.

关键词

Keywords

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