中國(guó)早期胃癌篩查流程專(zhuān)家共識(shí)意見(jiàn)

中國(guó)早期胃癌篩查流程專(zhuān)家共識(shí)意見(jiàn)一、本文概述Overviewofthisarticle胃癌作為全球范圍內(nèi)最常見(jiàn)的消化道惡性腫瘤之一，其發(fā)病率和死亡率均居高不下，嚴(yán)重威脅著人類(lèi)的生命健康。早期胃癌的篩查和診斷對(duì)于提高患者生存率和生活質(zhì)量具有重大意義。為此，本文旨在通過(guò)深入剖析胃癌的流行病學(xué)特征、高危因素、篩查技術(shù)和診斷方法，結(jié)合國(guó)內(nèi)外相關(guān)研究和實(shí)踐經(jīng)驗(yàn)，提出一套科學(xué)、實(shí)用、可操作的中國(guó)早期胃癌篩查流程專(zhuān)家共識(shí)意見(jiàn)。共識(shí)意見(jiàn)將圍繞篩查人群的選擇、篩查方法的應(yīng)用、診斷標(biāo)準(zhǔn)的制定以及后續(xù)治療與管理等方面展開(kāi)詳細(xì)闡述，以期為我國(guó)早期胃癌的篩查工作提供有力的理論支持和實(shí)踐指導(dǎo)。通過(guò)廣泛推廣和應(yīng)用本共識(shí)意見(jiàn)，我們期待能夠有效提高我國(guó)早期胃癌的檢出率，降低胃癌的發(fā)病率和死亡率，為推動(dòng)我國(guó)胃癌防治事業(yè)的持續(xù)發(fā)展貢獻(xiàn)力量。Gastriccancer,asoneofthemostcommonmalignanttumorsofdigestivetractintheworld,hasahighincidencerateandmortality,whichseriouslythreatenshumanlifeandhealth.Thescreeninganddiagnosisofearlygastriccancerisofgreatsignificanceforimprovingthesurvivalrateandqualityoflifeofpatients.Therefore,thisarticleaimstoproposeascientific,practical,andactionableexpertconsensusonthescreeningprocessforearlygastriccancerinChinabydeeplyanalyzingtheepidemiologicalcharacteristics,high-riskfactors,screeningtechniques,anddiagnosticmethodsofgastriccancer,andcombiningrelevantresearchandpracticalexperienceathomeandabroad.Theconsensuswillelaborateindetailontheselectionofscreeningpopulation,applicationofscreeningmethods,formulationofdiagnosticcriteria,andsubsequenttreatmentandmanagement,inordertoprovidestrongtheoreticalsupportandpracticalguidanceforthescreeningofearlygastriccancerinChina.Bywidelypromotingandapplyingthisconsensus,weexpecttoeffectivelyimprovethedetectionrateofearlygastriccancerinChina,reducetheincidencerateandmortalityofgastriccancer,andcontributetothesustainabledevelopmentofgastriccancerpreventionandtreatmentinChina.二、早期胃癌篩查的目標(biāo)人群Targetpopulationforearlygastriccancerscreening高危人群：長(zhǎng)期患有慢性萎縮性胃炎、慢性胃潰瘍、胃息肉、惡性貧血等胃癌前疾病的人群，以及有胃癌家族史的人群，都是早期胃癌篩查的重點(diǎn)對(duì)象。Highriskpopulation:Peoplewhosufferfromchronicatrophicgastritis,chronicgastriculcers,gastricpolyps,perniciousanemiaandotherpregastriccancerdiseasesforalongtime,aswellasthosewithafamilyhistoryofgastriccancer,arethefocusofearlygastriccancerscreening.年齡因素：胃癌的發(fā)病率隨著年齡的增長(zhǎng)而增加，因此，年齡大于40歲的人群應(yīng)列為早期胃癌篩查的重要目標(biāo)。Agefactor:Theincidencerateofgastriccancerincreaseswithage.Therefore,peopleover40yearsoldshouldbelistedasanimportantgoalofearlygastriccancerscreening.生活習(xí)慣和飲食習(xí)慣：長(zhǎng)期飲食不規(guī)律、喜食腌制、熏烤、高鹽等食物，以及長(zhǎng)期吸煙、飲酒等不良生活習(xí)慣的人群，也是早期胃癌篩查的重點(diǎn)關(guān)注對(duì)象。Lifestyleanddietaryhabits:Peoplewithlong-termirregulareatinghabits,apreferenceforpickled,smoked,andhighsaltfoods,aswellasunhealthyhabitssuchassmokinganddrinking,arealsothefocusofearlygastriccancerscreening.地理環(huán)境：胃癌的發(fā)病率與地理環(huán)境也有一定的關(guān)系，一些胃癌高發(fā)地區(qū)的人群應(yīng)列為早期胃癌篩查的目標(biāo)。Geographicalenvironment:Theincidencerateofgastriccancerisalsorelatedtothegeographicalenvironment,andthepopulationinsomeareaswithhighincidenceofgastriccancershouldbelistedasthetargetofearlygastriccancerscreening.其他因素：如有胃癌相關(guān)癥狀（如上腹部疼痛、消化不良、黑便等）的人群，以及長(zhǎng)期心理壓力過(guò)大、免疫功能低下等人群，也應(yīng)考慮列為早期胃癌篩查的目標(biāo)。Otherfactors:Peoplewithsymptomsrelatedtogastriccancer(suchasabdominalpain,indigestion,blackstools,etc.),aswellasthosewithlong-termpsychologicalstress,immunedysfunction,etc.,shouldalsobeconsideredastargetsforearlygastriccancerscreening.在確定早期胃癌篩查的目標(biāo)人群時(shí)，需要綜合考慮上述因素，并結(jié)合具體的臨床實(shí)際情況，制定出符合本地區(qū)、本醫(yī)院特點(diǎn)的早期胃癌篩查策略。對(duì)于不同的人群，應(yīng)采取不同的篩查方法和策略，以提高早期胃癌的檢出率和治愈率，降低胃癌的死亡率。Whendeterminingthetargetpopulationforearlygastriccancerscreening,itisnecessarytocomprehensivelyconsidertheabovefactorsandcombinethemwithspecificclinicalsituationstodevelopearlygastriccancerscreeningstrategiesthatareinlinewiththecharacteristicsoftheregionandthehospital.Differentscreeningmethodsandstrategiesshouldbeadoptedfordifferentpopulationstoimprovethedetectionandcureratesofearlygastriccancerandreducethemortalityrateofgastriccancer.三、早期胃癌篩查的方法與手段Methodsandmeansofearlygastriccancerscreening早期胃癌的篩查是一個(gè)多步驟、多手段的過(guò)程，旨在通過(guò)一系列的檢測(cè)方法，有效地識(shí)別出可能存在胃癌風(fēng)險(xiǎn)的人群，并對(duì)其進(jìn)行進(jìn)一步的診斷與治療。以下是我國(guó)專(zhuān)家在胃癌篩查方法與手段上的共識(shí)意見(jiàn)。Thescreeningofearlygastriccancerisamulti-stepandmulti-facetedprocessaimedateffectivelyidentifyingpopulationsatriskofgastriccancerthroughaseriesofdetectionmethods,andfurtherdiagnosingandtreatingthem.ThefollowingistheconsensusopinionofChineseexpertsonthemethodsandmeansofgastriccancerscreening.血清學(xué)檢測(cè)：血清學(xué)檢測(cè)是胃癌篩查的重要手段之一。通過(guò)檢測(cè)血清中的腫瘤標(biāo)志物，如胃蛋白酶原（PG）、胃泌素-17（G-17）等，可以初步評(píng)估個(gè)體的胃癌風(fēng)險(xiǎn)。當(dāng)這些腫瘤標(biāo)志物出現(xiàn)異常時(shí)，應(yīng)進(jìn)一步進(jìn)行胃鏡檢查以明確診斷。Serologicaltesting:Serologicaltestingisoneoftheimportantmethodsforscreeninggastriccancer.Bydetectingtumormarkersinserum,suchaspepsinogen(PG)andgastrin-17(G-17),anindividual'sriskofgastriccancercanbepreliminarilyevaluated.Whenthesetumormarkersshowabnormalities,furthergastroscopyexaminationshouldbeperformedtoclarifythediagnosis.胃鏡檢查：胃鏡是診斷胃癌的金標(biāo)準(zhǔn)，也是早期胃癌篩查的重要手段。通過(guò)胃鏡檢查，可以直接觀察胃黏膜的病變情況，并進(jìn)行組織活檢以明確診斷。對(duì)于高危人群，建議定期進(jìn)行胃鏡檢查，以便及時(shí)發(fā)現(xiàn)并治療早期胃癌。Gastroscopyexamination:Gastroscopyisthegoldstandardfordiagnosinggastriccancerandanimportantmeansofearlygastriccancerscreening.Throughgastroscopyexamination,thepathologicalchangesofthegastricmucosacanbedirectlyobserved,andtissuebiopsycanbeperformedtoclarifythediagnosis.Forhigh-riskindividuals,itisrecommendedtoundergoregulargastroscopyexaminationstopromptlydetectandtreatearlygastriccancer.內(nèi)鏡超聲檢查：內(nèi)鏡超聲檢查是一種先進(jìn)的胃癌診斷技術(shù)，可以在胃鏡下直接觀察胃壁的層次結(jié)構(gòu)，并評(píng)估腫瘤浸潤(rùn)的深度和范圍。這項(xiàng)技術(shù)對(duì)于早期胃癌的分期和手術(shù)治療方案的制定具有重要意義。Endoscopicultrasoundexamination:Endoscopicultrasoundexaminationisanadvanceddiagnostictechniqueforgastriccancer,whichcandirectlyobservethehierarchicalstructureofthegastricwallundergastroscopyandevaluatethedepthandextentoftumorinfiltration.Thistechnologyisofgreatsignificanceforthestagingofearlygastriccancerandthedevelopmentofsurgicaltreatmentplans.影像學(xué)檢查：影像學(xué)檢查如CT、MRI等，可以用于評(píng)估胃癌的遠(yuǎn)處轉(zhuǎn)移情況，以及手術(shù)前后的病情評(píng)估。這些檢查手段可以為臨床決策提供重要依據(jù)。Imagingexamination:ImagingexaminationssuchasCTandMRIcanbeusedtoevaluatethedistantmetastasisofgastriccancerandassesstheconditionbeforeandaftersurgery.Theseexaminationmethodscanprovideimportantbasisforclinicaldecision-making.基因檢測(cè)：近年來(lái)，基因檢測(cè)在胃癌篩查中的應(yīng)用逐漸受到關(guān)注。通過(guò)檢測(cè)與胃癌發(fā)生相關(guān)的基因變異，可以預(yù)測(cè)個(gè)體的胃癌風(fēng)險(xiǎn)，并為個(gè)體化治療提供指導(dǎo)。然而，目前基因檢測(cè)在胃癌篩查中的普及度和準(zhǔn)確性仍需進(jìn)一步提高。Genetictesting:Inrecentyears,theapplicationofgenetictestingingastriccancerscreeninghasgraduallyreceivedattention.Bydetectinggeneticvariationsassociatedwiththedevelopmentofgastriccancer,itispossibletopredictanindividual'sriskofgastriccancerandprovideguidanceforpersonalizedtreatment.However,thepopularityandaccuracyofgenetictestingingastriccancerscreeningstillneedtobefurtherimproved.早期胃癌的篩查需要綜合運(yùn)用多種方法與手段，包括血清學(xué)檢測(cè)、胃鏡檢查、內(nèi)鏡超聲檢查、影像學(xué)檢查和基因檢測(cè)等。通過(guò)合理的篩查策略和技術(shù)組合，我們可以提高早期胃癌的檢出率，為患者提供更好的治療機(jī)會(huì)和生活質(zhì)量。隨著科技的進(jìn)步和臨床經(jīng)驗(yàn)的積累，我們相信未來(lái)會(huì)有更多創(chuàng)新性的篩查方法問(wèn)世，為早期胃癌的防控工作帶來(lái)更多可能性。Thescreeningofearlygastriccancerrequiresthecomprehensiveuseofvariousmethodsandmeans,includingserologicaltesting,gastroscopy,endoscopicultrasoundexamination,imagingexamination,andgenetictesting.Throughareasonablescreeningstrategyandtechnologycombination,wecanimprovethedetectionrateofearlygastriccancer,providebettertreatmentopportunitiesandqualityoflifeforpatients.Withtheadvancementoftechnologyandtheaccumulationofclinicalexperience,webelievethatmoreinnovativescreeningmethodswillbeintroducedinthefuture,bringingmorepossibilitiesforthepreventionandcontrolofearlygastriccancer.四、早期胃癌篩查的流程與規(guī)范Theprocessandstandardsofearlygastriccancerscreening早期胃癌篩查的流程與規(guī)范是確保有效、安全、準(zhǔn)確地發(fā)現(xiàn)早期胃癌的關(guān)鍵環(huán)節(jié)。本共識(shí)意見(jiàn)提出以下建議：Theprocessandstandardsofearlygastriccancerscreeningarecrucialtoensureeffective,safe,andaccuratedetectionofearlygastriccancer.Thisconsensusproposesthefollowingsuggestions:篩查對(duì)象的確定：根據(jù)我國(guó)胃癌流行病學(xué)特點(diǎn)，建議將40歲及以上人群作為胃癌篩查的起始年齡，并考慮性別、地域、生活習(xí)慣等因素。對(duì)于有胃癌家族史、既往有慢性萎縮性胃炎、胃潰瘍、胃息肉等高危因素的人群，應(yīng)提前開(kāi)始篩查并增加篩查頻率。Determinationofscreeningtargets:BasedontheepidemiologicalcharacteristicsofgastriccancerinChina,itisrecommendedtoconsidertheageof40andaboveasthestartingageforgastriccancerscreening,takingintoaccountfactorssuchasgender,region,andlifestylehabits.Forindividualswithafamilyhistoryofgastriccancer,ahistoryofchronicatrophicgastritis,gastriculcers,gastricpolyps,andotherhigh-riskfactors,screeningshouldbeinitiatedinadvanceandthefrequencyofscreeningshouldbeincreased.篩查方法的選擇：推薦采用血清胃蛋白酶原（PG）檢測(cè)、幽門(mén)螺桿菌（Hp）檢測(cè)、胃鏡檢查等方法進(jìn)行早期胃癌篩查。血清PG檢測(cè)可反映胃黏膜狀態(tài)，有助于發(fā)現(xiàn)胃黏膜萎縮、腸化等癌前病變；Hp檢測(cè)可評(píng)估感染情況，對(duì)預(yù)防和治療胃癌有重要意義；胃鏡檢查是診斷早期胃癌的金標(biāo)準(zhǔn)，可直接觀察胃黏膜病變情況并取活檢確診。Selectionofscreeningmethods:Itisrecommendedtousemethodssuchasserumpepsinogen(PG)detection,Helicobacterpylori(Hp)detection,andgastroscopyforearlygastriccancerscreening.SerumPGdetectioncanreflectthestatusofgastricmucosaandhelpdetectprecancerouslesionssuchasgastricmucosalatrophyandintestinalmetaplasia;Hptestingcanevaluateinfectionstatusandisofgreatsignificanceforthepreventionandtreatmentofgastriccancer;Gastroscopyisthegoldstandardfordiagnosingearlygastriccancer,whichcandirectlyobservetheconditionofgastricmucosallesionsandtakebiopsyfordiagnosis.篩查流程的制定：建議采用分層級(jí)篩查流程，即先進(jìn)行血清PG和Hp檢測(cè)，對(duì)結(jié)果異常者進(jìn)行胃鏡檢查。對(duì)于高危人群，可直接進(jìn)行胃鏡檢查。同時(shí)，應(yīng)建立完善的隨訪機(jī)制，對(duì)篩查發(fā)現(xiàn)的癌前病變進(jìn)行定期監(jiān)測(cè)和干預(yù)。Developmentofscreeningprocess:Itisrecommendedtoadoptahierarchicalscreeningprocess,whichinvolvesfirstconductingserumPGandHptests,andthenconductinggastroscopyforthosewithabnormalresults.Forhigh-riskindividuals,gastroscopycanbeperformeddirectly.Atthesametime,acomprehensivefollow-upmechanismshouldbeestablishedtoregularlymonitorandinterveneinprecancerouslesionsdetectedthroughscreening.質(zhì)量控制與監(jiān)測(cè)：應(yīng)確保篩查過(guò)程的質(zhì)量控制，包括檢測(cè)方法的準(zhǔn)確性、操作規(guī)范性、數(shù)據(jù)完整性等。定期對(duì)篩查流程進(jìn)行評(píng)估和優(yōu)化，以提高早期胃癌的檢出率。Qualitycontrolandmonitoring:Thequalitycontrolofthescreeningprocessshouldbeensured,includingtheaccuracyoftestingmethods,operationalnorms,dataintegrity,etc.Regularlyevaluateandoptimizethescreeningprocesstoimprovethedetectionrateofearlygastriccancer.宣傳教育與健康促進(jìn)：加強(qiáng)公眾對(duì)早期胃癌篩查的認(rèn)識(shí)和重視，提高篩查參與率。通過(guò)健康教育、健康講座等方式普及胃癌防治知識(shí)，引導(dǎo)公眾養(yǎng)成健康的生活方式。Propagandaeducationandhealthpromotion:Strengthenpublicawarenessandattentiontoearlygastriccancerscreening,andincreasescreeningparticipationrate.Popularizeknowledgeongastriccancerpreventionandtreatmentthroughhealtheducation,healthlectures,andothermeans,guidingthepublictodevelopahealthylifestyle.通過(guò)實(shí)施以上篩查流程與規(guī)范，可以有效提高早期胃癌的檢出率，降低胃癌的發(fā)病率和死亡率，為我國(guó)胃癌防治工作做出積極貢獻(xiàn)。Byimplementingtheabovescreeningproceduresandnorms,wecaneffectivelyimprovethedetectionrateofearlygastriccancer,reducetheincidencerateandmortalityofgastriccancer,andmakepositivecontributionstothepreventionandtreatmentofgastriccancerinChina.五、早期胃癌篩查的質(zhì)量控制與評(píng)估Qualitycontrolandevaluationofearlygastriccancerscreening早期胃癌篩查的質(zhì)量控制與評(píng)估是確保篩查效果的關(guān)鍵環(huán)節(jié)。質(zhì)量控制涉及篩查流程的每個(gè)環(huán)節(jié)，包括篩查前的準(zhǔn)備、篩查過(guò)程的管理以及篩查后的數(shù)據(jù)處理和結(jié)果反饋。評(píng)估則是對(duì)整個(gè)篩查流程效果的定期檢查和評(píng)價(jià)，以便及時(shí)調(diào)整和改進(jìn)。Thequalitycontrolandevaluationofearlygastriccancerscreeningisakeylinkinensuringscreeningeffectiveness.Qualitycontrolinvolveseveryaspectofthescreeningprocess,includingpreparationbeforescreening,managementofthescreeningprocess,aswellasdataprocessingandresultfeedbackafterscreening.Evaluationisaregularcheckandevaluationoftheeffectivenessoftheentirescreeningprocess,inordertomaketimelyadjustmentsandimprovements.在質(zhì)量控制方面，首先需要對(duì)篩查人員進(jìn)行專(zhuān)業(yè)培訓(xùn)和資格認(rèn)證，確保他們具備足夠的醫(yī)學(xué)知識(shí)和操作技能。需要建立標(biāo)準(zhǔn)化的篩查流程和操作規(guī)范，包括胃鏡檢查的標(biāo)準(zhǔn)化操作流程、活檢的規(guī)范取材和處理等。還需要建立嚴(yán)格的數(shù)據(jù)管理和質(zhì)量控制體系，確保篩查數(shù)據(jù)的準(zhǔn)確性和完整性。Intermsofqualitycontrol,itisfirstnecessarytoprovideprofessionaltrainingandqualificationcertificationforscreeningpersonneltoensurethattheyhavesufficientmedicalknowledgeandoperationalskills.Itisnecessarytoestablishastandardizedscreeningprocessandoperatingprocedures,includingstandardizedoperatingproceduresforgastroscopy,standardizedsamplingandhandlingofbiopsies,etc.Itisalsonecessarytoestablishastrictdatamanagementandqualitycontrolsystemtoensuretheaccuracyandcompletenessofscreeningdata.在評(píng)估方面，需要定期對(duì)篩查流程進(jìn)行效果評(píng)價(jià)，包括篩查的敏感度、特異度、準(zhǔn)確率等指標(biāo)。還需要對(duì)篩查過(guò)程中出現(xiàn)的問(wèn)題和困難進(jìn)行分析和總結(jié)，以便及時(shí)調(diào)整和改進(jìn)篩查策略。還需要建立長(zhǎng)期隨訪機(jī)制，對(duì)篩查出的疑似病例進(jìn)行追蹤和監(jiān)測(cè)，以便及時(shí)發(fā)現(xiàn)和治療早期胃癌。Intermsofevaluation,itisnecessarytoregularlyevaluatetheeffectivenessofthescreeningprocess,includingindicatorssuchassensitivity,specificity,accuracy,etc.Itisalsonecessarytoanalyzeandsummarizetheproblemsanddifficultiesthatariseduringthescreeningprocess,inordertoadjustandimprovethescreeningstrategyinatimelymanner.Itisalsonecessarytoestablishalong-termfollow-upmechanismtotrackandmonitorsuspectedcasesscreened,inordertotimelydetectandtreatearlygastriccancer.早期胃癌篩查的質(zhì)量控制與評(píng)估是確保篩查效果的關(guān)鍵環(huán)節(jié)。通過(guò)嚴(yán)格的質(zhì)量控制和定期的效果評(píng)估，可以不斷提高篩查的準(zhǔn)確性和可靠性，為早期胃癌的防控提供有力支持。還需要不斷完善和優(yōu)化篩查流程和技術(shù)手段，以適應(yīng)不斷變化的胃癌防控形勢(shì)。Thequalitycontrolandevaluationofearlygastriccancerscreeningisakeylinkinensuringscreeningeffectiveness.Throughstrictqualitycontrolandregulareffectivenessevaluation,theaccuracyandreliabilityofscreeningcanbecontinuouslyimproved,providingstrongsupportforthepreventionandcontrolofearlygastriccancer.Westillneedtocontinuouslyimproveandoptimizethescreeningprocessandtechnicalmeanstoadapttotheconstantlychangingsituationofgastriccancerpreventionandcontrol.六、結(jié)論與建議Conclusionandrecommendations本共識(shí)基于當(dāng)前國(guó)內(nèi)外胃癌流行病學(xué)特征、篩查技術(shù)進(jìn)展及實(shí)踐經(jīng)驗(yàn)，提出了適合中國(guó)國(guó)情的早期胃癌篩查流程。我們認(rèn)為，胃癌的早期發(fā)現(xiàn)、早期診斷和早期治療對(duì)于降低胃癌死亡率、提高患者生存率和生活質(zhì)量具有重要意義。ThisconsensusproposesanearlygastriccancerscreeningprocesssuitableforChina'snationalconditionsbasedonthecurrentepidemiologicalcharacteristics,screeningtechnologyprogress,andpracticalexperienceofgastriccancerbothdomesticallyandinternationally.Webelievethatearlydetection,diagnosis,andtreatmentofgastriccancerareofgreatsignificanceinreducinggastriccancermortality,improvingpatientsurvivalrates,andimprovingqualityoflife.胃癌篩查應(yīng)納入國(guó)家公共衛(wèi)生體系，提高公眾對(duì)胃癌篩查的認(rèn)知度和參與度。Gastriccancerscreeningshouldbeincludedinthenationalpublichealthsystemtoincreasepublicawarenessandparticipationingastriccancerscreening.針對(duì)高危人群，推薦采用血清學(xué)檢測(cè)聯(lián)合胃鏡檢查作為主要的篩查手段，以提高早期胃癌的檢出率。Forhigh-riskpopulations,itisrecommendedtouseserologicaltestingcombinedwithgastroscopyasthemainscreeningmethodtoimprovethedetectionrateofearlygastriccancer.對(duì)于非高危人群，建議采用問(wèn)卷調(diào)查結(jié)合血清學(xué)檢測(cè)的方式進(jìn)行篩查，以降低成本并提高篩查效率。Fornonhigh-riskpopulations,itisrecommendedtouseacombinationofquest