Objective: To evaluate the patients' survival and effectiveness of the live cancer screening for population at high risk for liver cancer in Qidong. Methods: According to the Expert Scheme proposed the Expert Committee of Early Detection and Early Treatment, China Cancer Foundation, diagnostical screening by using combined methods of alpha-fetoprotein and B ultrasound monitoring were carried out biannually in individuals with positive HBsAg who were screened from Qidong area. The evaluation indices of the effectiveness are task completion rate of screening, detection rate of liver cancer, early diagnosis rate, and treatment rate. The deadline of the follow-up for the surviving outcome was March 31, 2016. The life-table method was used to calculate the observed survival, and to make comparison and significant tests between survival rates in Group A (those found via repeated periodic screening) and Group B (those diagnosed without periodic screening). Results: Since 2007, 38 016 target population have been screened, and 3 703(9.74%) individuals with positive HBsAg were found. Except for 29 patients with liver cancer at the initial screening, 3 674 persons in the cohort were followed up; 268 patients with liver cancer were detected from the 33 199 person-times screening, with an annual detection rate of 1.61%. Of them, 186 patients were found in Group A(1.12%), in which 149 patients were the early cases, with an early detection rate of 80.11%; 167 out of 186(89.78%) patients received treatment after diagnosis. The incidence of liver cancer in this HBsAg (+ ) cohort of 25 452 person-years was 1 052.96 per 100 000 annually, 187 cases in males(1 488.45/100 000)and 81 cases in females(628.46/100 000). The 1-, 3-, 5-, and 8-year survival of all patients with liver cancer were 64.55%, 40.50%, 32.54%, and 19.65%, respectively. The 1-, 3-, 5-, and 8-year survival rates were 77.16%, 49.04%, 38.53%, and 24.25% in Group A, and were 36.25%, 21.21%, 21.21%, and 0% in Group B, respectively, with significant differences between two groups (P<0.05). Conclusion: The findings show that screening of individuals at high-risk of development of liver cancer, with semiannual AFP and B ultrasound, according to the Expert Scheme, is effective not only in increasing detection rate but also in detecting liver cancer at early stage, and in improving patients' survival as well.
目的： 通过启东地区的肝癌筛查实践，探讨在肝癌高发区开展高风险人群肝癌筛检的筛查效果。 方法： 根据中国癌症基金会癌症早诊早治专家委员会制订的方案，对启东地区筛查发现的乙肝表面抗原(HBsAg)阳性者，采用甲胎蛋白(AFP)联合超声检测的方法开展每年2次的诊断性筛查，评估筛查效果的指标为任务完成率、肝癌检出率、早诊率和治疗率。对筛查患者开展随访，随访截至2016年3月31日。采用寿命表法计算观察生存率，并比较反复筛查组和自动就诊组患者的生存率。 结果： 2007年以来，启东地区筛查目标人群38 016人，发现HBsAg阳性者3 703人，阳性率为9.74%。排除初筛时发现的29例肝癌患者，实际随访队列人数为3 674人，共完成诊断性筛查33 199人次，发现肝癌268例，肝癌检出率为1.61%。其中通过反复筛检发现的肝癌186例，检出率为1.12%；早期病例149例，肝癌早诊率为80.11%；186例肝癌患者中，接受治疗167例，治疗率为89.78%。按HBsAg阳性者队列共随访25 452.00人年计，肝癌年均发生率为1 052.96/10万，其中男性和女性分别发生肝癌187和81例，发生率分别为1 488.45/10万和628.46/10万。队列中所有肝癌患者的1、3、5、8年生存率分别为64.55%、40.50%、32.54%和19.65%。反复筛查组患者的1、3、5、8年生存率分别为77.16%、49.04%、38.53%和24.25%；自动就诊组患者的1、3、5、8年生存率分别为36.25%、21.21%、21.21%和0%，两组患者的生存率差异均有统计学意义(均P<0.05)。 结论： 启东肝癌的筛查实践证实，严格按照专家方案，采用AFP联合超声检测的方法，对肝癌高风险人群开展每年2次的筛查，可以提高肝癌的检出率、早诊率，通过积极的治疗，可以提高患者的生存率，提高肝癌筛查的效果。.
Keywords: Follow-up; HBsAg; Liver neoplasms; Screening; Secondary prevention; Survival.