消化道早癌筛查技术的革新与临床应用

Innovation and Clinical Application of Early Gastrointestinal Cancer Screening Technology

摘要: 消化道癌症是全球重大公共卫生问题，发病与死亡病例分别占全球癌症的26%与35%，疾病负担沉重。早期诊断是改善预后的核心，早期患者五年生存率可超90%，晚期则骤降至30%以下，因此通过筛查实现早发现、早干预是降低死亡率的关键。但不同消化道癌种的筛查发展极不均衡：结直肠癌已建立全球公认的“非侵入性初筛 + 内镜精查”分级筛查体系，而胃癌筛查全球共识度低、地区差异显著，仅东亚高发病率国家开展区域性筛查，多数国家尚未形成标准化全民筛查方案。当前筛查体系仍面临瓶颈，现有技术无法同时满足高准确性、高可及性与低成本的核心需求。本文系统梳理了消化道早癌筛查技术从传统到革新的演变，评析各类技术的原理、临床证据与应用价值，重点阐述人工智能、液体活检、新型光学成像三大革新技术的进展，并结合结直肠癌与胃癌筛查体系的本质差异，探讨新技术针对性嵌入与优化现有筛查路径的差异化策略，总结挑战与未来方向，为优化筛查策略提供参考。

Abstract: Gastrointestinal cancer is a major global public health problem, with its incidence and death cases accounting for 26% and 35% of global cancers respectively, with a heavy disease burden. Early diagnosis is the core to improve patients’ prognosis: the 5-year survival rate of early-stage patients can exceed 90%, while that of advanced-stage patients drops sharply to less than 30%. Therefore, early detection and intervention through screening is the key strategy to reduce mortality. However, the development of screening strategies varies significantly among different gastrointestinal cancers: colorectal cancer has established a globally recognized hierarchical screening system of “non-invasive initial screening + endoscopic definitive examination”, while gastric cancer screening has low global consensus and significant regional disparities. Only high-incidence countries in East Asia carry out regional screening, and most countries have not yet formed a standardized national screening program. However, the current screening system faces many bottlenecks, and existing technologies cannot meet the core requirements of high accuracy, high accessibility and low cost. This paper systematically reviews the evolution of early gastrointestinal cancer screening technologies, evaluates the principles, clinical evidence and application value of various technologies, focuses on the progress of three core innovative technologies: artificial intelligence, liquid biopsy and new optical imaging, and discusses the differentiated strategies for targeted integration and optimization of existing screening pathways by combining the essential differences between colorectal cancer and gastric cancer screening systems, and summarizes challenges and future directions, to provide academic reference for optimizing screening strategies.