Analysis Of Screening Results Of Liver Cancer High-risk Groups In Early Diagnosis And Early Treatment Program In Huaihe River Basin,Anhui Province

Objective Liver cancer is an important public health problem threatening the life and health of Chinese people.It is characterized by high morbidity,high mortality and low survival rate.Early diagnosis and treatment program of abdominal B-ultrasonography combined with serum alpha-fetoprotein(AFP)screening in high-risk groups of liver cancer plays an important role in reducing mortality and improving survival rate.However,the screening participation rate of high-risk groups for liver cancer in China is not high,and the cost effectiveness of early diagnosis and treatment of liver cancer in the general population is not high.Therefore,on the basis of the early diagnosis and treatment of liver cancer project in Huaihe River Basin of Anhui Province,this study studied the screening participation rate and detection rate of high-risk groups of liver cancer,and discussed the influencing factors respectively,making a preliminary conclusion for this project and providing scientific basis for exploring more suitable local screening and early diagnosis and treatment of liver cancer.MethodsFrom 2013 to 2018,A total of 322717 residents aged 35-65 with local household registration were selected and invited to participate in this project using cluster sampling methods from six counties around Huaihe River in Anhui province.A total of69949 individuals at high-risk for liver cancer was assessed using health factors questionnaire and testing of hepatitis B virus surface antigen(HBs Ag).34957 individuals with high-risk for liver cancer participated in further clinical screenings for liver cancer,including abdominal B-ultrasound examination and serum alphafetoprotein detection.Chi-square test and logistic regression model was used to explore the related factors to detection rate of liver cancer.Results(1)A total of 322,717 respondents were included in this survey,and 69,949 people were screened out as high-risk groups for liver cancer,with a high-risk rate of 21.68%.(2)Among them,34,957 participated in clinical screening for liver cancer,a screening participation rate of 49.97 percent.(3)Participants and non-participants were screened in terms of survey year,survey region,gender,age,drinking water source,education level,obesity level,frequent smoking,alcohol consumption,liver cirrhosis and HBs Ag detection,history of digestive tract diseases,number of digestive tract symptoms,family history of digestive tract cancer,fresh vegetables,fresh fruits,salted and sun-cured foods and moldy foods The difference in consumption frequency was statistically significant(P<0.05).(4)After multi-factor analysis,it is shown that: Compared with 2013,the participation rate of liver cancer screening in high-risk groups was lower in 2014(OR=0.935,95%CI=0.892～0.980)and 2015(OR=0.828,95%CI=0.789～0.868),and in 2017(OR=1.152,95%CI=1.064～1.247)and 2018(OR=1.261,95%CI=1.167～1.363).In comparison with the yongqiao district in Suzhou city,Yingdong District in Fuyang City(OR=0.255,95%CI= 0.238～0.273),Mengcheng County in Bozhou City(OR=0.870,95%CI= 0.816～0.928),Wuhe County in Bengbu City(OR=0.927,95%CI=0.873～0.984),Yingshang County of Fuyang City(OR=0.343,95%CI=0.316～0.371)had a lower participation rate,and Lingbi County of Suzhou City(OR=1.307,95%CI=1.221～1.399)had a higher participation rate.Women had a higher participation rate than men(OR=2.099,95%CI= 2.008～2.194).Compared with 35 to 40 years old,41 to 50 years old(OR=1.612,95%CI=1.500～1.732),51 to 60 years old(OR=2.194,95%CI=2.039～2.360),61 to 64 years old(OR=2.609,95%CI=2.410～2.824)the participation rate of screening was higher and increased with age.Compared with those who used tap water as the main source of water,those who drank shallow water(OR=1.078,95%CI=1.029～1.129)and those who drank deep well water/spring water(OR=1.259,95%CI=1.198～1.323)had a higher participation rate.The participation rate of primary school students(OR=1.143,95%CI= 1.091～1.197)and secondary school/junior college students(OR=1.234,95%CI= 1.176～1.296)or above was higher than that of students without formal schooling.Compared with normal-weight subjects,obese subjects(OR=1.143,95%CI= 1.087～1.203)had a higher participation rate in screening.The participation rate of regular smokers was higher than that of non-regular smokers(OR=2.694,95%CI= 2.576～2.818).There was a higher participation rate in screening among drinkers compared with non-drinkers(OR=3.826,95%CI=3.661～4.000);Compared with those without cirrhosis and HBs Ag negative,those with cirrhosis only(OR=7.154,95%CI= 6.802～7.524),those with HBs Ag positive only(OR=16.233,95%CI=10.418～25.293)and HBs Ag positive patients with cirrhosis(OR=24.704,95%CI=17.888～34.117)had higher participation rates and increased accordingly.Compared with those without a history of digestive tract,those with a history of digestive tract had a higher participation rate(OR=2.122,95%CI=2.026～2.222).Compared with those with a family history of digestive tract cancer,those with a family history of digestive tract cancer had a higher participation rate(OR=61.695,95%CI= 59.237～64.255).Compared with those without any gastrointestinal symptoms,those with one to two symptoms(OR=22.001,95%CI=20.859～23.205)and more than three symptoms(OR=39.443,95%CI=36.310～42.847)had a higher participation rate,and increased with the number of symptoms.(5)A total of 182 cases of liver cancer were detected,the detection rate was 0.52%.(6)There were statistically significant differences in survey year,gender,age,degree of obesity,alcohol consumption,liver cirrhosis and HBs Ag detection,history of digestive tract diseases,number of digestive tract symptoms,family history of digestive tract cancer,and consumption frequency of fresh fruits,pickled and dried foods and moldy foods between detected and undetected groups(P<0.05).(7)The results of multivariate analysis showed that the detection rate of liver cancer was lower in females(OR=0.435,95%CI= 0.307～0.616).Compared with the 61-64 age group,the liver cancer detection rate was lower in the 35-40 age group(OR=0.135,95%CI= 0.032～0.561)and the 41-50 age group(OR=0.618,95%CI= 0.413～0.925).Compared with the normal body weight group,the liver cancer detection rate was lower in overweight(OR=0.712,95%CI= 0.522～0.973)and obese(OR=0.390,95%CI=0.207～0.735)groups.Compared with those without cirrhosis and HBs Ag negative test,only cirrhosis(OR=7.250,95%CI: 5.142～10.221)and HBs Ag positive(OR=14.781,95%CI:5.199～42.026)and HBs Ag positive patients with cirrhosis(OR=59.408,95%CI:37.620～93.814)had a high detection rate of liver cancer.Compared with those without digestive tract related symptoms,patients with more than 3 digestive tract related symptoms(OR=2.189,95%CI=1.474～3.251)had a higher detection rate of liver cancer.ConclusionsThe project of early Diagnosis and Treatment of liver Cancer in Huaihe River Basin of Anhui Province is conducive to the early detection and diagnosis of liver cancer,but the enthusiasm for liver cancer screening needs to be improved.The participation rate of screening in the high-risk population of liver cancer was related to the survey year,survey area,gender,age,drinking water source,education level,obesity degree,regular smoking,drinking status,liver cirrhosis and HBs Ag,history of gastrointestinal disease,number of gastrointestinal symptoms,and family history of gastrointestinal cancer.The detection rate of liver cancer was related to gender,age,obesity,cirrhosis,HBs Ag detection and the number of liver cancer-related symptoms.