中国早期胃癌筛查流程专家共识意见

中国早期胃癌筛查流程专家共识意见一、本文概述Overviewofthisarticle胃癌作为全球范围内最常见的消化道恶性肿瘤之一，其发病率和死亡率均居高不下，严重威胁着人类的生命健康。早期胃癌的筛查和诊断对于提高患者生存率和生活质量具有重大意义。为此，本文旨在通过深入剖析胃癌的流行病学特征、高危因素、筛查技术和诊断方法，结合国内外相关研究和实践经验，提出一套科学、实用、可操作的中国早期胃癌筛查流程专家共识意见。共识意见将围绕筛查人群的选择、筛查方法的应用、诊断标准的制定以及后续治疗与管理等方面展开详细阐述，以期为我国早期胃癌的筛查工作提供有力的理论支持和实践指导。通过广泛推广和应用本共识意见，我们期待能够有效提高我国早期胃癌的检出率，降低胃癌的发病率和死亡率，为推动我国胃癌防治事业的持续发展贡献力量。Gastriccancer,asoneofthemostcommonmalignanttumorsofdigestivetractintheworld,hasahighincidencerateandmortality,whichseriouslythreatenshumanlifeandhealth.Thescreeninganddiagnosisofearlygastriccancerisofgreatsignificanceforimprovingthesurvivalrateandqualityoflifeofpatients.Therefore,thisarticleaimstoproposeascientific,practical,andactionableexpertconsensusonthescreeningprocessforearlygastriccancerinChinabydeeplyanalyzingtheepidemiologicalcharacteristics,high-riskfactors,screeningtechniques,anddiagnosticmethodsofgastriccancer,andcombiningrelevantresearchandpracticalexperienceathomeandabroad.Theconsensuswillelaborateindetailontheselectionofscreeningpopulation,applicationofscreeningmethods,formulationofdiagnosticcriteria,andsubsequenttreatmentandmanagement,inordertoprovidestrongtheoreticalsupportandpracticalguidanceforthescreeningofearlygastriccancerinChina.Bywidelypromotingandapplyingthisconsensus,weexpecttoeffectivelyimprovethedetectionrateofearlygastriccancerinChina,reducetheincidencerateandmortalityofgastriccancer,andcontributetothesustainabledevelopmentofgastriccancerpreventionandtreatmentinChina.二、早期胃癌筛查的目标人群Targetpopulationforearlygastriccancerscreening高危人群：长期患有慢性萎缩性胃炎、慢性胃溃疡、胃息肉、恶性贫血等胃癌前疾病的人群，以及有胃癌家族史的人群，都是早期胃癌筛查的重点对象。Highriskpopulation:Peoplewhosufferfromchronicatrophicgastritis,chronicgastriculcers,gastricpolyps,perniciousanemiaandotherpregastriccancerdiseasesforalongtime,aswellasthosewithafamilyhistoryofgastriccancer,arethefocusofearlygastriccancerscreening.年龄因素：胃癌的发病率随着年龄的增长而增加，因此，年龄大于40岁的人群应列为早期胃癌筛查的重要目标。Agefactor:Theincidencerateofgastriccancerincreaseswithage.Therefore,peopleover40yearsoldshouldbelistedasanimportantgoalofearlygastriccancerscreening.生活习惯和饮食习惯：长期饮食不规律、喜食腌制、熏烤、高盐等食物，以及长期吸烟、饮酒等不良生活习惯的人群，也是早期胃癌筛查的重点关注对象。Lifestyleanddietaryhabits:Peoplewithlong-termirregulareatinghabits,apreferenceforpickled,smoked,andhighsaltfoods,aswellasunhealthyhabitssuchassmokinganddrinking,arealsothefocusofearlygastriccancerscreening.地理环境：胃癌的发病率与地理环境也有一定的关系，一些胃癌高发地区的人群应列为早期胃癌筛查的目标。Geographicalenvironment:Theincidencerateofgastriccancerisalsorelatedtothegeographicalenvironment,andthepopulationinsomeareaswithhighincidenceofgastriccancershouldbelistedasthetargetofearlygastriccancerscreening.其他因素：如有胃癌相关症状（如上腹部疼痛、消化不良、黑便等）的人群，以及长期心理压力过大、免疫功能低下等人群，也应考虑列为早期胃癌筛查的目标。Otherfactors:Peoplewithsymptomsrelatedtogastriccancer(suchasabdominalpain,indigestion,blackstools,etc.),aswellasthosewithlong-termpsychologicalstress,immunedysfunction,etc.,shouldalsobeconsideredastargetsforearlygastriccancerscreening.在确定早期胃癌筛查的目标人群时，需要综合考虑上述因素，并结合具体的临床实际情况，制定出符合本地区、本医院特点的早期胃癌筛查策略。对于不同的人群，应采取不同的筛查方法和策略，以提高早期胃癌的检出率和治愈率，降低胃癌的死亡率。Whendeterminingthetargetpopulationforearlygastriccancerscreening,itisnecessarytocomprehensivelyconsidertheabovefactorsandcombinethemwithspecificclinicalsituationstodevelopearlygastriccancerscreeningstrategiesthatareinlinewiththecharacteristicsoftheregionandthehospital.Differentscreeningmethodsandstrategiesshouldbeadoptedfordifferentpopulationstoimprovethedetectionandcureratesofearlygastriccancerandreducethemortalityrateofgastriccancer.三、早期胃癌筛查的方法与手段Methodsandmeansofearlygastriccancerscreening早期胃癌的筛查是一个多步骤、多手段的过程，旨在通过一系列的检测方法，有效地识别出可能存在胃癌风险的人群，并对其进行进一步的诊断与治疗。以下是我国专家在胃癌筛查方法与手段上的共识意见。Thescreeningofearlygastriccancerisamulti-stepandmulti-facetedprocessaimedateffectivelyidentifyingpopulationsatriskofgastriccancerthroughaseriesofdetectionmethods,andfurtherdiagnosingandtreatingthem.ThefollowingistheconsensusopinionofChineseexpertsonthemethodsandmeansofgastriccancerscreening.血清学检测：血清学检测是胃癌筛查的重要手段之一。通过检测血清中的肿瘤标志物，如胃蛋白酶原（PG）、胃泌素-17（G-17）等，可以初步评估个体的胃癌风险。当这些肿瘤标志物出现异常时，应进一步进行胃镜检查以明确诊断。Serologicaltesting:Serologicaltestingisoneoftheimportantmethodsforscreeninggastriccancer.Bydetectingtumormarkersinserum,suchaspepsinogen(PG)andgastrin-17(G-17),anindividual'sriskofgastriccancercanbepreliminarilyevaluated.Whenthesetumormarkersshowabnormalities,furthergastroscopyexaminationshouldbeperformedtoclarifythediagnosis.胃镜检查：胃镜是诊断胃癌的金标准，也是早期胃癌筛查的重要手段。通过胃镜检查，可以直接观察胃黏膜的病变情况，并进行组织活检以明确诊断。对于高危人群，建议定期进行胃镜检查，以便及时发现并治疗早期胃癌。Gastroscopyexamination:Gastroscopyisthegoldstandardfordiagnosinggastriccancerandanimportantmeansofearlygastriccancerscreening.Throughgastroscopyexamination,thepathologicalchangesofthegastricmucosacanbedirectlyobserved,andtissuebiopsycanbeperformedtoclarifythediagnosis.Forhigh-riskindividuals,itisrecommendedtoundergoregulargastroscopyexaminationstopromptlydetectandtreatearlygastriccancer.内镜超声检查：内镜超声检查是一种先进的胃癌诊断技术，可以在胃镜下直接观察胃壁的层次结构，并评估肿瘤浸润的深度和范围。这项技术对于早期胃癌的分期和手术治疗方案的制定具有重要意义。Endoscopicultrasoundexamination:Endoscopicultrasoundexaminationisanadvanceddiagnostictechniqueforgastriccancer,whichcandirectlyobservethehierarchicalstructureofthegastricwallundergastroscopyandevaluatethedepthandextentoftumorinfiltration.Thistechnologyisofgreatsignificanceforthestagingofearlygastriccancerandthedevelopmentofsurgicaltreatmentplans.影像学检查：影像学检查如CT、MRI等，可以用于评估胃癌的远处转移情况，以及手术前后的病情评估。这些检查手段可以为临床决策提供重要依据。Imagingexamination:ImagingexaminationssuchasCTandMRIcanbeusedtoevaluatethedistantmetastasisofgastriccancerandassesstheconditionbeforeandaftersurgery.Theseexaminationmethodscanprovideimportantbasisforclinicaldecision-making.基因检测：近年来，基因检测在胃癌筛查中的应用逐渐受到关注。通过检测与胃癌发生相关的基因变异，可以预测个体的胃癌风险，并为个体化治疗提供指导。然而，目前基因检测在胃癌筛查中的普及度和准确性仍需进一步提高。Genetictesting:Inrecentyears,theapplicationofgenetictestingingastriccancerscreeninghasgraduallyreceivedattention.Bydetectinggeneticvariationsassociatedwiththedevelopmentofgastriccancer,itispossibletopredictanindividual'sriskofgastriccancerandprovideguidanceforpersonalizedtreatment.However,thepopularityandaccuracyofgenetictestingingastriccancerscreeningstillneedtobefurtherimproved.早期胃癌的筛查需要综合运用多种方法与手段，包括血清学检测、胃镜检查、内镜超声检查、影像学检查和基因检测等。通过合理的筛查策略和技术组合，我们可以提高早期胃癌的检出率，为患者提供更好的治疗机会和生活质量。随着科技的进步和临床经验的积累，我们相信未来会有更多创新性的筛查方法问世，为早期胃癌的防控工作带来更多可能性。Thescreeningofearlygastriccancerrequiresthecomprehensiveuseofvariousmethodsandmeans,includingserologicaltesting,gastroscopy,endoscopicultrasoundexamination,imagingexamination,andgenetictesting.Throughareasonablescreeningstrategyandtechnologycombination,wecanimprovethedetectionrateofearlygastriccancer,providebettertreatmentopportunitiesandqualityoflifeforpatients.Withtheadvancementoftechnologyandtheaccumulationofclinicalexperience,webelievethatmoreinnovativescreeningmethodswillbeintroducedinthefuture,bringingmorepossibilitiesforthepreventionandcontrolofearlygastriccancer.四、早期胃癌筛查的流程与规范Theprocessandstandardsofearlygastriccancerscreening早期胃癌筛查的流程与规范是确保有效、安全、准确地发现早期胃癌的关键环节。本共识意见提出以下建议：Theprocessandstandardsofearlygastriccancerscreeningarecrucialtoensureeffective,safe,andaccuratedetectionofearlygastriccancer.Thisconsensusproposesthefollowingsuggestions:筛查对象的确定：根据我国胃癌流行病学特点，建议将40岁及以上人群作为胃癌筛查的起始年龄，并考虑性别、地域、生活习惯等因素。对于有胃癌家族史、既往有慢性萎缩性胃炎、胃溃疡、胃息肉等高危因素的人群，应提前开始筛查并增加筛查频率。Determinationofscreeningtargets:BasedontheepidemiologicalcharacteristicsofgastriccancerinChina,itisrecommendedtoconsidertheageof40andaboveasthestartingageforgastriccancerscreening,takingintoaccountfactorssuchasgender,region,andlifestylehabits.Forindividualswithafamilyhistoryofgastriccancer,ahistoryofchronicatrophicgastritis,gastriculcers,gastricpolyps,andotherhigh-riskfactors,screeningshouldbeinitiatedinadvanceandthefrequencyofscreeningshouldbeincreased.筛查方法的选择：推荐采用血清胃蛋白酶原（PG）检测、幽门螺杆菌（Hp）检测、胃镜检查等方法进行早期胃癌筛查。血清PG检测可反映胃黏膜状态，有助于发现胃黏膜萎缩、肠化等癌前病变；Hp检测可评估感染情况，对预防和治疗胃癌有重要意义；胃镜检查是诊断早期胃癌的金标准，可直接观察胃黏膜病变情况并取活检确诊。Selectionofscreeningmethods:Itisrecommendedtousemethodssuchasserumpepsinogen(PG)detection,Helicobacterpylori(Hp)detection,andgastroscopyforearlygastriccancerscreening.SerumPGdetectioncanreflectthestatusofgastricmucosaandhelpdetectprecancerouslesionssuchasgastricmucosalatrophyandintestinalmetaplasia;Hptestingcanevaluateinfectionstatusandisofgreatsignificanceforthepreventionandtreatmentofgastriccancer;Gastroscopyisthegoldstandardfordiagnosingearlygastriccancer,whichcandirectlyobservetheconditionofgastricmucosallesionsandtakebiopsyfordiagnosis.筛查流程的制定：建议采用分层级筛查流程，即先进行血清PG和Hp检测，对结果异常者进行胃镜检查。对于高危人群，可直接进行胃镜检查。同时，应建立完善的随访机制，对筛查发现的癌前病变进行定期监测和干预。Developmentofscreeningprocess:Itisrecommendedtoadoptahierarchicalscreeningprocess,whichinvolvesfirstconductingserumPGandHptests,andthenconductinggastroscopyforthosewithabnormalresults.Forhigh-riskindividuals,gastroscopycanbeperformeddirectly.Atthesametime,acomprehensivefollow-upmechanismshouldbeestablishedtoregularlymonitorandinterveneinprecancerouslesionsdetectedthroughscreening.质量控制与监测：应确保筛查过程的质量控制，包括检测方法的准确性、操作规范性、数据完整性等。定期对筛查流程进行评估和优化，以提高早期胃癌的检出率。Qualitycontrolandmonitoring:Thequalitycontrolofthescreeningprocessshouldbeensured,includingtheaccuracyoftestingmethods,operationalnorms,dataintegrity,etc.Regularlyevaluateandoptimizethescreeningprocesstoimprovethedetectionrateofearlygastriccancer.宣传教育与健康促进：加强公众对早期胃癌筛查的认识和重视，提高筛查参与率。通过健康教育、健康讲座等方式普及胃癌防治知识，引导公众养成健康的生活方式。Propagandaeducationandhealthpromotion:Strengthenpublicawarenessandattentiontoearlygastriccancerscreening,andincreasescreeningparticipationrate.Popularizeknowledgeongastriccancerpreventionandtreatmentthroughhealtheducation,healthlectures,andothermeans,guidingthepublictodevelopahealthylifestyle.通过实施以上筛查流程与规范，可以有效提高早期胃癌的检出率，降低胃癌的发病率和死亡率，为我国胃癌防治工作做出积极贡献。Byimplementingtheabovescreeningproceduresandnorms,wecaneffectivelyimprovethedetectionrateofearlygastriccancer,reducetheincidencerateandmortalityofgastriccancer,andmakepositivecontributionstothepreventionandtreatmentofgastriccancerinChina.五、早期胃癌筛查的质量控制与评估Qualitycontrolandevaluationofearlygastriccancerscreening早期胃癌筛查的质量控制与评估是确保筛查效果的关键环节。质量控制涉及筛查流程的每个环节，包括筛查前的准备、筛查过程的管理以及筛查后的数据处理和结果反馈。评估则是对整个筛查流程效果的定期检查和评价，以便及时调整和改进。Thequalitycontrolandevaluationofearlygastriccancerscreeningisakeylinkinensuringscreeningeffectiveness.Qualitycontrolinvolveseveryaspectofthescreeningprocess,includingpreparationbeforescreening,managementofthescreeningprocess,aswellasdataprocessingandresultfeedbackafterscreening.Evaluationisaregularcheckandevaluationoftheeffectivenessoftheentirescreeningprocess,inordertomaketimelyadjustmentsandimprovements.在质量控制方面，首先需要对筛查人员进行专业培训和资格认证，确保他们具备足够的医学知识和操作技能。需要建立标准化的筛查流程和操作规范，包括胃镜检查的标准化操作流程、活检的规范取材和处理等。还需要建立严格的数据管理和质量控制体系，确保筛查数据的准确性和完整性。Intermsofqualitycontrol,itisfirstnecessarytoprovideprofessionaltrainingandqualificationcertificationforscreeningpersonneltoensurethattheyhavesufficientmedicalknowledgeandoperationalskills.Itisnecessarytoestablishastandardizedscreeningprocessandoperatingprocedures,includingstandardizedoperatingproceduresforgastroscopy,standardizedsamplingandhandlingofbiopsies,etc.Itisalsonecessarytoestablishastrictdatamanagementandqualitycontrolsystemtoensuretheaccuracyandcompletenessofscreeningdata.在评估方面，需要定期对筛查流程进行效果评价，包括筛查的敏感度、特异度、准确率等指标。还需要对筛查过程中出现的问题和困难进行分析和总结，以便及时调整和改进筛查策略。还需要建立长期随访机制，对筛查出的疑似病例进行追踪和监测，以便及时发现和治疗早期胃癌。Intermsofevaluation,itisnecessarytoregularlyevaluatetheeffectivenessofthescreeningprocess,includingindicatorssuchassensitivity,specificity,accuracy,etc.Itisalsonecessarytoanalyzeandsummarizetheproblemsanddifficultiesthatariseduringthescreeningprocess,inordertoadjustandimprovethescreeningstrategyinatimelymanner.Itisalsonecessarytoestablishalong-termfollow-upmechanismtotrackandmonitorsuspectedcasesscreened,inordertotimelydetectandtreatearlygastriccancer.早期胃癌筛查的质量控制与评估是确保筛查效果的关键环节。通过严格的质量控制和定期的效果评估，可以不断提高筛查的准确性和可靠性，为早期胃癌的防控提供有力支持。还需要不断完善和优化筛查流程和技术手段，以适应不断变化的胃癌防控形势。Thequalitycontrolandevaluationofearlygastriccancerscreeningisakeylinkinensuringscreeningeffectiveness.Throughstrictqualitycontrolandregulareffectivenessevaluation,theaccuracyandreliabilityofscreeningcanbecontinuouslyimproved,providingstrongsupportforthepreventionandcontrolofearlygastriccancer.Westillneedtocontinuouslyimproveandoptimizethescreeningprocessandtechnicalmeanstoadapttotheconstantlychangingsituationofgastriccancerpreventionandcontrol.六、结论与建议Conclusionandrecommendations本共识基于当前国内外胃癌流行病学特征、筛查技术进展及实践经验，提出了适合中国国情的早期胃癌筛查流程。我们认为，胃癌的早期发现、早期诊断和早期治疗对于降低胃癌死亡率、提高患者生存率和生活质量具有重要意义。ThisconsensusproposesanearlygastriccancerscreeningprocesssuitableforChina'snationalconditionsbasedonthecurrentepidemiologicalcharacteristics,screeningtechnologyprogress,andpracticalexperienceofgastriccancerbothdomesticallyandinternationally.Webelievethatearlydetection,diagnosis,andtreatmentofgastriccancerareofgreatsignificanceinreducinggastriccancermortality,improvingpatientsurvivalrates,andimprovingqualityoflife.胃癌筛查应纳入国家公共卫生体系，提高公众对胃癌筛查的认知度和参与度。Gastriccancerscreeningshouldbeincludedinthenationalpublichealthsystemtoincreasepublicawarenessandparticipationingastriccancerscreening.针对高危人群，推荐采用血清学检测联合胃镜检查作为主要的筛查手段，以提高早期胃癌的检出率。Forhigh-riskpopulations,itisrecommendedtouseserologicaltestingcombinedwithgastroscopyasthemainscreeningmethodtoimprovethedetectionrateofearlygastriccancer.对于非高危人群，建议采用问卷调查结合血清学检测的方式进行筛查，以降低成本并提高筛查效率。Fornonhigh-riskpopulations,itisrecommendedtouseacombinationofquest