| Objective : Based on of a meta-analysis, to discuss the dangerous factors of cancer ( lung cancer, gastric cancer and liver cancer ) in the elderly of Soochow City; Based on of fisher discriminant analysis, to establish an evaluating model of the cancer high-risk groups, to wit"the specific software for the primary screening of the cancer high-risk groups"; Eventually, to construct a practical, whole-course, networking and standardized of integrative management system for the prevention and cure of incipient tumors, with preventing and curing as the starting point, with"Screening/ Second-screening/ Precision-examination/ Diagnosis"as the core, combining community health service and the hospital service, and to provide the theoretical and practical basis for a reliable means of the prevention and cure of incipient tumors.Method :1. Meta-analysis : Through literature searching and evaluating, the epidemiological studies on risk factors of cancer from 1995 to 2010 were analyzed synthetically by Meta-analysis.2. Based on of Fisher discriminant analysis, Establishing an evaluating model of the cancer high-risk groups, to wit"the specific software for the primary screening of of the cancer high-risk groups": Preliminarily diagnosed patients of the cancer ( lung cancer, gastric cancer and liver cancer ) were selected between Jan, 2009 and Jan, 2010 in the 1st Hospital Affiliated to Soochow University. In a 1 : 1 case-control study, with corresponding age and sex as a control group, the article used the methods of investigating, questionnaire and tracking telephone to collect information about correlative dangerous factors of each person both in cases and controls.3. The"Community-Hospital"integrative management system for the prevention and cure of incipient tumors : To combine community health service and the hospital service by way of the application of computer network and resource sharing. Community as the flat, health education was intervened, medical examination and screening by the specific software were checked in middle-aged or elder people of the trial communities. According to the result of"Screening/ Second-screening/ Precision-examination/ Diagnosis", medical intervention and monitoring with individuation were carried out among high-risk groups.Results:1. Meta-analysis1.1. The risk factors of lung cancer combined odds ratio (OR) and 95% credibility interval (95% CI ) were: Smoking (X1) OR = 2.028 (1.784～2.273), Smoking index (X2) OR = 1.192 (1.135～1.249), Passive smoking (X3) OR = 1.826 (1.609～2.042), soot (X4) OR = 2.247 (1.759～2.735), Tuberculosis (X5) OR = 1.413 (0.935～1.891), Chronic bronchitis (X6) OR = 1.689 (1.358～2.020), Other pulmonary diseases (X7) OR = 1.947 (1.692～2.201), Family history of malignant (X8) OR = 1.487 (1.250～1.725), Psycho-mental factors (X9) OR = 1.713 (1.424～2.001), Factory contaminates around the residence (X10) OR = 1.426 (0.932～1.921), Ill dietary customs (X11) OR = 1.868 (1.586～2.150), and Taking in fruit and vegetable (X12) OR = 0.361 (0.319～0.402).1.2. The risk factors of gastric cancer combined OR and 95% CI were: History of Helicobacter pylori infection (X1) OR = 5.243 (1.323～9.163), History of chronic gastritis (X2) OR = 1.103 (1.050～1.157), Family history of malignant (X3) OR = 1.694 (1.504～1.883), Psycho-mental factors (X4) OR = 1.065 (1.030～1.101), Smoking (X5) OR = 1.063 (1.034～1.091), Drinking (X6) OR = 1.202 (1.130～1.274), High salt diet (X7) OR = 1.506 (1.397～1.616), Being fond of very hot foods (X8) OR = 1.445 (1.323～1.567), and Quick at meal (X9) OR = 2.093 (1.681～2.504).1.3. The risk factor of liver cancer combined OR and 95% CI were: Cirrhosis (X1) OR = 14.122 (2.437～27.807), Chronic second liver (X2) OR = 2.319 (1.897～2.741), HBsAg (+) (X3) OR = 7.205 (5.858～8.552), History of HCV infection (X4) OR = 1.973 (1.089～2.859), Family history of malignant (X5) OR = 2.418 (2.102～2.733), Psycho-mental factors (X6) OR = 1.861 (1.642～2.079), Drinking (X7) OR = 1.219 (1.143～1.295), Smoking (X8) OR = 1.083 (1.045～1.121), and Non-running-water (X9) OR = 2.085 (1.607～2.562).2. Based on of Fisher discriminant analysis, establishing an evaluating model of the cancer high-risk groups, to wit"the specific software for the primary screening of the cancer high-risk groups":2.1. The forecast model for the high-risk of lung cancer : Y1=-4.582+3.051X1+3.195X2+1.358X3+2.133X4+2.307X5+1.713X6+2.479X7+1.460X8+1.945X9+1.952X10+1.790X11+1.561X12; The forecast model for the non-high-risk of lung cancer : Y2=-1.603+1.776X1+0.770X2+1.044X3+1.137X4+0.851X5+0.966X6+1.075X7+0.949X8+1.049X9+1.342X10+1.282X11+1.912X12. The specificity was 82.30%, the sensitivity was 74.45%, negative predictive value was 83.47%, and positive predictive value was 70.66%.2.2. The forecast model for the high-risk of gastric cancer : Y1=-4.284+2.907X1+1.780X2+1.978X3+1.311X4+2.335X5+1.811X6+2.697X7+2.032X8+1.937X9; The forecast model for the non-high-risk of gastric cancer : Y2=-2.122+2.40X1+0.724X2+0.990X3+1.121X4+1.573X5+1.062X6+1.726X7+1.486X8+1.372X9.The specificity was 66.72%, the sensitivity was 68.59%, negative predictive value was 66.53%, and positive predictive value was 67.33%.2.3. The forecast model for the high-risk of liver cancer : Y1=-6.658+4.080X1+3.644X2+5.455X3+1.486X4+2.162X5+1.812X6+2.663X7+3.070X8+2.006X9; The forecast model for the non-high-risk of liver cancer : Y2=-1.286+0.435X1+0.269X2+0.641X3+0.327X4+0.830X5+0.377X6+1.749X7+2.321X8+1.222X9.The specificity was 96.19%, the sensitivity was 83.81%, negative predictive value was 96.67%, and positive predictive value was 82.22%. 3. The"Community-Hospital"integrative management system for the prevention and cure of incipient tumors : We have successfully constructed the integrative management system for the prevention and cure of incipient tumors, with community as a basic element of cancer screening, with finding out the cancer high-risk groups from general population as the key step, with"Screening/ Second-screening/ Precision-examination/ Diagnosis"as the core. Building a bridge between the community health service and the hospital service, the cancer high-risk groups have got a whole-course, networking and standardized management; Related health education, screening results and information of diagnosis, treatment and follow-up, the data is dynamic renewal and has been received a full application, The study has been provided the theoretical and practical basis for a reliable means of the prevention and cure of incipient tumors.4. Screening out the cancer high-risk groups from general population by the specific software which established based on Meta-analysis and fisher discriminant analysis, the cancer high-risk groups are put into an optimal management system for early prevention and cure of incipient tumors, which saves the early diagnosis cost. The correct diagnosis rates of lung cancer, gastric cancer and liver cancer were 0.44%, 0.39%, 0.32%, respectively (P<0.05); The early diagnosis rates were 27.91%, 23.68% and 32.26%, respectively (P<0.05); And the treatment rate were 76.74%, 81.58%, 80.65%, respectively (P<0.05). The elevation of the early diagnosis and therapy rate provided the foundation for the decline in death rates.Conclusion : Based on of the research and application of the specific software, we have successfully constructed the integrative management system for the prevention and cure of incipient tumors, with community as a basic element of cancer screening, with finding out the cancer high-risk groups from general population as the key step, with"Screening/ Second-screening/ Precision-examination/ Diagnosis"as the core. Building a bridge between the community health service and the hospital service, the cancer high-risk groups have got a whole-course, networking and standardized management; As an effective attempt to achieve the objective of early finding, early diagnosis and early treatment, the study provided an advanced case and application demonstration in the province and even in the whole country. |
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