【专家述评】| 结直肠癌早筛、早诊、早治上海方案 （2023年版）

［摘要］ 结直肠癌是中国常见的恶性肿瘤，目前中国结直肠癌发病率和死亡率呈不断上升趋势，在中国全部恶性肿瘤中发病率位居第2位、死亡率位居第4位，已成为严重威胁人类生命健康的公共卫生问题。大量的研究和实践表明，结直肠癌早筛、早诊、早治是降低结直肠癌患者死亡率的有效措施。上海市自2013年起，持续开展社区结直肠癌筛查，通过早期筛查发现癌前病变、降低发病风险，早期诊断结直肠癌并进行及时治疗，显著延长了结直肠癌患者的生存期。同时，上海市各大医院规范化诊治水平较高，结直肠癌患者5年生存率也相对较高，甚至超过欧美发达国家。但由于地区差异和经济发展的不平衡，中国大部分地区仍未开展结直肠癌相关防治项目，同时，由于基层医院业务能力不足，较低的早期诊断率及早期治疗率成为限制中国结直肠癌患者预后进一步提高的瓶颈。针对基层医院对于结直肠癌背景、风险预防、常用筛查手段、规范性诊断和治疗等方面认知不足的现状，上海市抗癌协会大肠癌专业委员会组织上海各大医院结直肠癌诊治专家，共同编写《结直肠癌早筛、早诊、早治上海方案（2023年版）》，方案从结直肠癌的流行病学、危险因素及保护因素、癌前病变及早期结直肠癌、筛查、早期结直肠癌的诊断和早期结直肠癌的治疗等6个方面进行了详尽介绍，并提供了相关建议供临床医师参考。本方案旨在规范结直肠癌筛查与早诊、早治实践，提升中国结直肠癌的防治效果。结直肠癌的早筛、早诊、早治是提高患者生存率和改善患者预后的关键。目前，结直肠癌虽然已有多种筛查方法，但仍存在灵敏度和特异度不足等问题，同时在全国众多医院，结直肠癌的诊断和治疗还存在着规范化的问题。因此，未来结直肠癌防治之路除了开发更高效的筛查方法、提高早期诊断准确率及探索更安全有效的治疗方法外，还需要在诊断和治疗上为基层医院提供帮扶，强调结直肠癌的诊断和治疗规范化，提高基层医师的诊治水平，提升基层医院的诊治能力，最后还应加强公众健康教育，提高公众对结直肠癌的认知和预防意识。

［关键词］ 结直肠癌；早筛；早诊；早治

［Abstract］ Colorectal cancer is a common malignant tumor in China. At present, the incidence rate and the mortality rate of colorectal cancer in China are on the rise. Among all malignant tumors in China, the incidence rate of colorectal cancer ranks second, and the mortality rate ranks fourth. It has become a public health problem that seriously threatens our health. A large number of studies and practice have shown that colorectal cancer screening, early diagnosis and treatment are effective measures to reduce the mortality rate of colorectal cancer in the population. Since 2013, Shanghai has continued to carry out community colorectal cancer screening, which greatly extends the survival period of colorectal cancer patients by early detection of precancerous lesions, reducing the risk of disease, early diagnosis of colorectal cancer and timely treatment. At the same time, the standardized diagnosis and treatment level of major hospitals in Shanghai is relatively high, and the 5-year survival rate of colorectal cancer patients is also relatively high, even exceeding that of the developed countries in Europe and America. However, due to regional differences and uneven economic development, most regions in China have not yet carried out colorectal cancer-related prevention and treatment projects. At the same time, due to the lack of clinical service capacity of primary hospitals, the low early diagnosis and early treatment rates have become a bottleneck restricting the further improvement of the prognosis of colorectal cancer patients in China. In response to the current situation of insufficient clinical service capabilities in primary hospitals in terms of colorectal cancer-related knowledge, risk prevention knowledge, common screening methods, standardized diagnosis, treatment knowledge, etc., the Colorectal Cancer Special Committee of Shanghai Anti-Cancer Association organized colorectal cancer diagnosis and treatment experts from major hospitals in Shanghai to jointly compile the “Shanghai plan for early screening, diagnosis and treatment of colorectal cancer (2023 edition)”. The plan introduced the epidemiology of colorectal cancer, risk factors and protective factors of colorectal cancer, precancerous lesions of colorectal cancer and early colorectal cancer, screening of colorectal cancer, diagnosis of early colorectal cancer and treatment of early colorectal cancer, and provided relevant suggestions for clinical reference. The protocol aimed to standardize the screening, early diagnosis and early treatment practice of colorectal cancer, and improve the prevention and treatment of colorectal cancer in China. Early screening, diagnosis and treatment of colorectal cancer are keys to improving patient survival rates and prognosis. Currently, although there are various screening methods for colorectal cancer, there are still problems of insufficient sensitivity and specificity. At the same time, in many hospitals across the country, there are also problems of standardization in the diagnosis and treatment of colorectal cancer. Therefore, in the future, in addition to developing more efficient screening methods, improving the accuracy of early diagnosis and exploring safer and more effective treatment methods, the prevention and treatment of colorectal cancer also requires providing assistance to primary hospitals in diagnosis and treatment, emphasizing the standardization of colorectal cancer diagnosis and treatment, improving the diagnosis and treatment level of primary doctors, enhancing the diagnosis and treatment abilityies of primary hospitals and finally strengthening public health education to improve public awareness of colorectal cancer and prevention.

［Key words］ Colorectal cancer; Early screening; Early diagnosis; Early treatment