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目的 寻找一个有效可行的大肠癌早期筛选模式;探索一个理想的分期标准,简单易记易行并能为临床提供有效的预测预后的信息。方法 利用3次人群病例对照研究数据筛选大肠癌高危因素,并优化人群筛选模式。进行现场数据的回代验证,比较序贯筛检方案与优化方案的敏感性、特异度及约登指数。1722人群研究用于优化方案的评估。从1980年～1995年共1334例经病理诊断为大肠癌的病例进行了3年、5年、10年的生存率分析。所有的统计分析均以0.05作为有意义值。生存统计分析使用SPSS10.0软件。结果 优化筛检方案只需要填写一个简单的调查表和RPHA-FOB检查,而敏感度、特异度与约登指数都优于序贯筛检方案。在1 722人群中检出4例Dukes’A期与5例Dukes’B期。大肠癌临床病理分期分析发现,浸润至浆膜层与侵袭穿透浆膜外或直肠肠管外生存率有明显差别(P<0.05)。侵及浆膜层组3年、5年、10年生存率分别为0.67±0.02,0.58± 0.02,0.46±0.02;而侵袭穿透浆膜外或直肠肠管外组生存率分别为0.50±0.03,0.42±0.03,0.29±0.03。浸润至浆膜层组的生存率高于侵袭穿透浆膜外或直肠肠管外组。因此,在病理分期上应划分成两个不同时期。结论 优化方案是一个有效可行的大肠癌早期筛检方案。由于在粘膜(包括粘膜下)与固有肌层(浅及深)在10年
OBJECTIVE: To find an effective early screening model of colorectal cancer and to explore an ideal staging criteria that is easy to remember and provides an effective prognostic information for clinical practice. Methods The data of 3 case-control studies were used to screen the risk factors of colorectal cancer and to optimize the population screening model. Field data validation, comparison of sequential screening programs and optimization programs sensitivity, specificity and Youden index. 1722 Crowd Study Used to Evaluate Optimization Schemes. From 1980 to 1995 a total of 1334 cases of pathological diagnosis of colorectal cancer cases were 3 years, 5 years, 10-year survival analysis. All statistical analyzes used 0.05 as a meaningful value. Survival statistical analysis using SPSS 10.0 software. Results The optimized screening program only needed to fill in a simple questionnaire and RPHA-FOB examination, while the sensitivity, specificity and Youden index were better than the sequential screening program. Four out of 1722 people were found to have Dukes’A and Dukes’B. Clinicopathological analysis of colorectal cancer showed that there was a significant difference (P <0.05) in the survival rate between invasion and serosal invasion outside the serosa or rectum. The 3-year, 5-year and 10-year survival rates of invasive and serosal layers were 0.67 ± 0.02, 0.58 ± 0.02 and 0.46 ± 0.02, respectively. The survival rates of invasion outside the serosal or rectal group were 0.50 ± 0.03, 0.42 ± 0.03, 0.29 ± 0.03. Survival rate of infiltration into the serosal layer group was higher than invasion outside the serosal or rectal group. Therefore, the pathological staging should be divided into two different periods. Conclusion The optimized protocol is an effective and feasible screening program for colorectal cancer. Due to the mucosa (including submucosal) with the muscularis propria (shallow and deep) at 10 years