中国结直肠癌筛查效果meta分析

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摘要目的系统评价问卷调查结合便潜血的筛查方法在中国开展结直肠癌的筛查效果。方法计算机检索中国知网、万方、PubMed、EBSCO等中文和外文数据库，并辅以参考文献追溯和手工检索方法，查找结直肠癌初筛人群数量≥5000例的研究文献。检索时限为建库时间至2016年6月。采用R3.3.1软件进行meta分析。通过初筛阳性率、结直肠病变检出率和早诊率、结直肠癌检出率，来分析筛查效果，并对结直肠病变检出率进行分层分析。结果最终纳入28篇文献，共3 398 895人接受筛查。meta分析结果显示：初筛阳性率为14%[95%CI（11%～19%），P ＜ 0.0001]。结直肠病变检出率为16%[95%CI（12%～19%），P ＜ 0.0001]，其中早诊率为93%[95%CI（92%～95%），P ＜ 0.0001]。结直肠癌的检出率为1%[95%CI（1%～2%），P ＜ 0.0001]。对结直肠病变检出率分层分析发现：城市（17%）高于农村（8%）；南方地区（15%）略高于北方（12%）；基于体检人群开展大肠癌伺机性筛查的结果（13%）略低于社区自然人群（16%）。结论问卷调查结合便潜血的结直肠癌序贯筛查方法可增加初筛阳性率，适合肠镜依从性差的地区。

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	袁平马杏凡

关键词 ：结直肠癌, 筛查, 效果, meta分析

Abstract：Objective To systematically evaluate the effectiveness of screening for colorectal cancer in China by questionnaire survey combined with fecal occult blood tests. Methods Computer search was conducted on CNKI, WanFang, PubMed, EBSCO and other Chinese and foreign language databases, supplemented by reference tracing and manual search methods, to find literatures with a population of more than 5000 in the primary screening population of colorectal cancer. The retrieval time was from the database construction to June 2016. R3.3.1 software was used for meta-analysis. The screening effect was analyzed by the initial screening positive rate, the detection rate and early diagnosis rate of colorectal lesions and the detection rate of colorectal cancer, and the detection rate of colorectal lesions was analyzed by stratification. Results In the end, 28 articles were included, and a total of 3 398 895 people were screened. Meta-analysis results showed that the initial screening positive rate was 14% [95%CI (11%-19%), P ＜ 0.0001]. The detection rate of colorectal lesions was 16% [95%CI (12%-19%), P ＜ 0.0001], and the early diagnosis rate was 93% [95%CI (92%-95%), P ＜ 0.0001]. The detection rate of colorectal cancer was 1% [95%CI (1%-2%), P ＜ 0.0001]. Stratified analysis of the detection rate of colorectal lesions found that: urban (17%) was higher than rural (8%), the South (15%) was slightly higher than the North (12%), the results of opportunistic colorectal cancer screening based on physical population (13%) were slightly lower than those of the natural community population (16%). Conclusion The questionnaire survey combined with the sequential screening method of fecal occult blood for colorectal cancer can increase the positive rate of initial screening, suitable for areas with poor compliance with colonoscopy.

Key words： Colorectal cancer Screening Effect Meta analysis

基金资助:北京市科技计划项目（Z161100000516003）。

作者简介: 袁平（1984-），女，硕士，副研究员，北京大学首钢医院中心实验室副主任；研究方向：肿瘤防控。

引用本文:

袁平马杏凡. 中国结直肠癌筛查效果meta分析[J]. 中国医药导报, 2020, 17(8): 106-112.
YUAN Ping MA Xingfan. Meta-analysis on the effect of colorectal cancer screening in China. 中国医药导报, 2020, 17(8): 106-112.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I8/106

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