Abstract: Objective　To explore the economic benefits of risk-based screening of pancreatic cancer，providing a new way for screening of pancreatic cancer.Methods　Literature review was used to identify the risk factors of pancreatic cancer： using "pancreatic cancer" and "risk factors" or "etiology" as the search terms，we searched the electronic databases of CNKI，Wanfang Data Knowledge Service Platform and Web of Science for studies concerning the risk factors of pancreatic cancer collected from their inception to February 28，2018.We recorded and counted the number and reference rate of risk factors of pancreatic cancer extracted from the eligible studies．Models established with the data of risk-based screening of pancreatic cancer in Shanghai's Pudong New Area with CA19-9 assay were used for the economic analysis.Results　Totaled 121 studies were included，involving 19 risk factors of pancreatic cancer.As the two leading risk factors，smoking〔71.9%（87/121）〕 and diabetes〔59.5%（72/121）〕produced positive additive interaction on the incidence of pancreatic cancer〔SI=1.989，AOR（95%CI）=29.943（5.358，167.332）〕，we incorporated them in the pancreatic cancer screening conducted in Shanghai's Pudong New Area.Compared with the whole-population screening，the costs of screening of pancreatic cancer in smokers，diabetics，smokers with diabetes decreased by 90.462%，83.523%，96.377%-96.922%，respectively，while the efficiencies of these three types of screening increased by 948.4%，506.9%，2 894.3%，respectively. Conclusion　Risk-based screening of pancreatic cancer is of great significance.Screening of pancreatic cancer based on the combination of risk factors provides a new way of pancreatic cancer screening，it can narrow the target populations quickly and accurately，thereby the screening of pancreatic cancer in a region can be completed in a shorter period of time with lower costs.

Key words: Pancreatic neoplasms, Risk factors, Screening, Cost-benefit analysis

摘要： 目的　探讨结合高危因素进行胰腺癌筛查的经济效益，从而为胰腺癌筛查提供新的研究视角。方法　采用文献研究法收集胰腺癌的高危因素：以“胰腺癌（pancreatic cancer）”and“危险因素（risk factors）”or“病因（etiology）”为检索条件，在中国知网、万方数据知识服务平台、Web of Science中检索与胰腺癌危险因素相关的文献，检索日期为建库至2018-02-28。记录并统计合格文献中的胰腺癌危险因素及提及率。构建癌症筛查替代的经济效益模型，以癌抗原19-9（CA19-9）检测为筛查方法，以上海市浦东新区为例，分析结合高危因素进行胰腺癌筛查的经济效益。结果　文献研究共获得合格文献121篇，涵盖胰腺癌危险因素19个，最终选取的高危因素为提及率排在前2位的吸烟〔71.9%（87/121）〕、糖尿病〔59.5%（72/121）〕因素，二者对胰腺癌发病的影响存在正相加交互作用〔SI=1.989，AOR（95%CI）=29.943（5.358，167.332）〕。相较于全人群筛查，结合吸烟因素进行胰腺癌筛查的筛查成本降低了90.462%，筛查效率提高了948.4%；结合糖尿病因素进行胰腺癌筛查的筛查成本降低了83.523%，筛查效率提高了506.9%；结合吸烟和糖尿病交互作用进行胰腺癌筛查的筛查成本降低了96.377%~96.922%，筛查效率提高了2 894.3%。结论　利用高危因素改进胰腺癌的筛查方式具有重要意义，结合高危因素交互作用进行胰腺癌筛查，可以快速准确地缩小目标人群范围，以更短的时间、更低的成本，完成对某地区的胰腺癌筛查。

关键词: 胰腺肿瘤, 危险因素, 筛查, 费用效益分析