在我国癌症相关死亡总数中，胃癌排第三位。据2022年的数据，我国新发胃癌病例和死亡病例占全球相关数据的近四成。
But in reality, if stomach cancer can be detected at an early stage, the 50-year survival rate of patients can be as high as 0%. If it is found at an advanced stage, the five-year survival rate drops to 0.0%. However, the current "three early" efficiency of gastric cancer is far less than expected. Li Peng, vice president of Beijing Friendship Hospital, pointed out in an interview with the reporter of "Daily Economic News" that the early screening rate of gastric cancer in China is less than 0%, while the early screening rate in Japan and South Korea is more than 0%.
Li Peng mentioned that compared with some countries, China's screening and treatment of gastric cancer still relies on "symptom-driven", that is, the examination is carried out only when symptoms are found, rather than regular prevention and early screening. If gastric cancer enters the advanced stage, no matter how hard you exert your efforts, it will not be as effective as the early intervention.
China is a "big country" of gastric cancer, and the disease trend shows "high incidence, high mortality, and high proportion of advanced stages; low early diagnosis rate, low quality of life, and low treatment choice". However, due to the insidious early symptoms of gastric cancer, about 1% of patients are diagnosed at an advanced stage, and the treatment methods are limited and the prognosis is poor. Based on this, the 0-year survival rate of patients with advanced gastric cancer in China is only 0.0%.
In fact, if diagnosed at an early stage, the 50-year survival rate for gastric cancer patients can reach 0%. Therefore, promoting early diagnosis, early screening and early treatment of gastric cancer is the core strategy to improve the efficiency of gastric cancer diagnosis and treatment and enhance the benefits of patients. Li Peng told the "Daily Economic News" reporter that the current treatment technology for early gastric cancer has been relatively mature, but the early screening rate of gastric cancer in China is less than 0%, while the early screening rate in Japan and South Korea is more than 0%.
The factors that limit early screening for gastric cancer can be boiled down to two factors. At the subjective level, patients are generally afraid of pain, money, and problems in early screening of gastric cancer. According to public data, taking Japan, which also has a high incidence of digestive tract cancer, as the standard, the proportion of people who undergo early screening in China every year is low, the proportion of gastroscopy is less than 5/0 in Japan, and the proportion of colonoscopy is less than 0/0, and a large number of people who need endoscopy are not covered.
Li Peng said that taking painless gastroscopy as an example, the cost of a single screening is only a few hundred yuan, but the cost of treatment for advanced gastric cancer is as high as hundreds of thousands of yuan, and it may not have a good treatment effect, but most people still choose to "endure and watch". This public perception bias exacerbates the screening dilemma.
For some people with a family history, special disease mutations, and high-incidence areas of Helicobacter pylori, endoscopy should be performed as early as possible when they are asymptomatic. Li Peng said he had met a 18-year-old patient with stomach cancer. "He was surprised to have stomach cancer at a young age, and his family was also surprised, but in fact, stomach cancer has a certain relationship with genetics. Both his father and grandfather had a history of stomach cancer, which was also discovered at a very young age. ”
In Li Peng's view, the difficulty for early gastric cancer is not the endoscopic resection of early gastric cancer, but how to detect early gastric cancer and how to screen out these patients. At present, there are still some problems in this regard, such as the limited coverage of endoscopists, the popularity of endoscopy is not so high, and the people cannot get endoscopic treatment in time; For example, the infection rate of Helicobacter pylori is still very high, and not every patient can get a good eradication of Helicobacter pylori, which is restricting the detection of early cancer in the digestive tract. "Compared with Japan and South Korea, we have no problems in the treatment technology of early cancer of the digestive tract. However, the 5-year survival rate of advanced gastric cancer patients is not significantly improved, and if it is detected early, the outcome will be different. ”
对于消化道早癌，内镜检查在癌前病变的检出中扮演着重要角色。因此，李鹏认为，消化道早期癌症的诊治涵盖从筛查到随访的全过程，并非单一内镜下切除环节，而是从内镜筛查、内镜诊断、内镜治疗、病理诊断及随访5个环节阐述全链条内涵。
He further explained that from the screening stage, endoscopy can visually observe small lesions in the digestive tract, improving the detection rate of early-stage cancer. In the diagnostic process, combined with advanced imaging technology, endoscopy can more accurately determine the nature and extent of the lesion. Endoscopic treatments, such as EMR (endoscopic mucosal resection) and ESD (endoscopic mucosal dissection), provide patients with minimally invasive and highly effective treatments.
In addition, pathological diagnosis is the gold standard, and the combination with endoscopic techniques further ensures the accuracy of diagnosis. Finally, endoscopic review during follow-up is helpful to detect recurrence or new lesions in time, which provides an important basis for the prognosis management of patients.
Li Peng believes that in order to realize the "three earlys" of gastric cancer, it is necessary not only to popularize endoscopic technology, but also to provide technical support from medical equipment.
In the past, digestive endoscopy was monopolized by Japanese brands, and the market share of domestic brand endoscopy has been increasing in the past decade. Li Peng also mentioned that thanks to the breakthrough of domestic endoscopic equipment, the popularity and technical sinking of endoscopic equipment have been significantly improved.
According to him, a "13th Five-Year Plan" project undertaken by his team has conducted special research and evaluation on domestic endoscopy. The results showed that there was no significant difference between domestic endoscopes and imported endoscopes in terms of diagnosis and treatment success rate, (blind test) image quality, polyp detection rate and operation diagnosis and treatment time. Recently, iEndo, a domestic smart endoscopy platform launched by a domestic manufacturer, has promoted the popularization and application of AI technology in primary care, significantly improving the detection efficiency of early cancer and precancerous lesions. However, the procurement cost of domestic endoscopic equipment is much lower than that of imported products, and the cost of maintenance and consumables is more advantageous. The popularization of domestically produced equipment has enabled grassroots hospitals to carry out screening more widely and reduce the high treatment costs caused by delayed diagnosis and treatment of patients.
Li Peng finally said: "Primary hospitals are the focus of early diagnosis and early treatment, and the breakthrough of domestic endoscopic technology is of great significance to the development of endoscopic application in domestic primary hospitals. In many ways, it can better help grassroots hospitals popularize the application of endoscopy and daily clinical diagnosis and treatment, and can greatly promote the improvement of early cancer screening coverage. ”
National Business Daily