目的]评价上海市肝癌高危人群的监测方案。[方法]以35岁～55岁的乙肝抗原抗体阳性或有慢性肝炎史的18816名上海市民随机分为筛查组(9373人)与对照组(9443人)。筛查组每六个月作一次AFP与实时超声检查 ,检出的可疑病例即进入诊断程序 ,一旦确诊 ,且有手术指征者皆动员作手术切除 ;对照组不作任何主动检查 ,但发病的肝癌病人亦同样为之争取手术切除或其他积极的治疗 ,并随访其生存期。[结果]筛查组共筛查38444人年 ,检出肝癌86例。对照组共观察41077人年 ,发现肝癌67例。两组肝癌病例相比 ,筛查组Ⅰ期肝癌占60 5 % ,对照组为0(P<0 01)。筛查组小肝癌占45 3 % ,对照组为0(P<0 01)。筛查组能作手术切除的占46 5% ,而对照组7 5 % ,差异有统计学意义(P<0 01)。筛查组肝癌的1至5年生存率分别为65 9 %、59 9%、52 6 %、52 6 %和46 4% ,而对照组为31 2%、7 2 %、7 2 %、0和0。筛查组中肝癌死亡率为83 2/10万 ,对照组为131 5/10万 ,两组肝癌死亡率比为0 63。[结论]本研究结果说明筛查确能检出早期肝癌。通过积极治疗 ,筛查组肝癌病人的远期生存率显著高于对照组 ,肝癌二级预防确能降低肝癌的死亡率 Objectives] To evaluate the monitoring program for high-risk people with liver cancer in Shanghai. [Methods] A total of 18816 Shanghai residents aged 35-55 years with hepatitis B antigen-antibody positive or chronic hepatitis history were randomly divided into screening group (9373) and control group (9443). AFP and real-time ultrasonography were performed every six months in the screening group. Suspected cases were entered into the diagnostic procedure. Once diagnosed, surgical indications were mobilized for surgical resection. The control group did not make any active examination, but the incidence of Liver cancer patients also strive for surgical resection or other active treatment, and follow-up of their survival. [Results] A total of 38,444 man-years were screened in the screening group and 86 cases of liver cancer were detected. A total of 41077 person-years were observed in the control group, and 67 liver cancer cases were found. Compared with the two groups of liver cancer cases, screening stage I liver cancer accounted for 60.5%, and control group 0 (P<0 01). Small hepatocellular carcinoma accounted for 45 3% in the screening group and 0 in the control group (P<0 01). 46% of patients in the screening group were able to undergo surgical resection and 75% in the control group, and the difference was statistically significant (P<0.01). The 1- to 5-year survival rates of liver cancer in the screening group were 659.9%, 59.9%, 52.6%, 52.6%, and 46.4%, respectively, while those in the control group were 31.8%, 72%, 72%, and 0. And 0. The mortality rate of hepatocellular carcinoma in the screening group was 83 2/100 000, and that of the control group was 13 15/100 000. The ratio of liver cancer mortality between the two groups was 0 63. [Conclusion] The results of this study indicate that screening can detect early stage liver cancer. Through active treatment, the long-term survival rate of liver cancer patients in the screening group was significantly higher than that of the control group. Secondary prevention of liver cancer can actually reduce the mortality of liver cancer.