发病率与死亡率

经估计,2013年美国食管癌新发病例和死亡病例数分别为:[1]

新发病例数:17,990例。

死亡病例数:15,210例。

数十年来,食管癌的发病率逐渐上升,同时伴随着组织学类型及原发肿瘤部位的改变[2][3]。现在,在美国和西欧,食管腺癌已取代食管鳞癌成为更为常见的组织类型,同时远端食管则成为肿瘤最高发部位。引起发病率上升及人口统计学变化的原因尚未可知。

尽管鳞癌的危险因素已被确认(如烟草、酒精及饮食习惯等),与食管腺癌相关的危险因素却还不清楚[3]。研究显示Barrett食管与食管腺癌患病风险增加有关,而慢性返流症状被认为是导致Barrett化生的重要原因。瑞典一项基于人群的病例对照研究结果提示症状性胃食管返流症与食管腺癌的发生有很强的相关性。返流症状的发生频率、严重程度、持续时间均与食管腺癌患病风险呈正相关[4]

食管癌是一种可以治疗但难以治愈的疾病。按照标准方案治疗的患者,其总体5年生存率在5%-30%之间。若患者为偶然发现且疾病位于极早期阶段,其治愈的几率则更大。远段食管的Barrett粘膜具有重度不典型增生的患者其不典型增生区域常伴随原位癌甚至浸润癌。通过切除原发病灶,这些患者通常会有良好预后。

主要的治疗方法包括单独手术治疗或同步放化疗。综合治疗(如化疗联合手术、或放化疗联合手术)的效果目前仍处于临床评估阶段。不同的综合疗法方案对个体病例中有良好的症状缓解作用,这些方案包括联合使用手术、化学疗法、放射治疗、支架治疗[5]、光动力疗法[6][7][8] 以及经内镜Nd:YAG激光治疗[9]

为食管癌病人对比和选择治疗手段时,一个重要难题是缺乏准确的术前分期。无创分期方法包括胸腹部的计算机断层扫描(CT)及内镜下超声(EUS)。EUS判断肿瘤浸润深度的总正确率高达85%-90%,CT的正确率为50%-80%;在区域淋巴结转移分期方面,EUS和CT的总正确率分别为70%-80%和50%-70%[10][11] 。EUS引导下细针抽吸穿刺(FNA)用于淋巴结分期仍然处于前瞻性评估阶段;已有一项回顾性系列研究显示,EUS-FNA用于区域淋巴结分期的敏感性和特异性分别为93%和100%[12] 。在某些外科中心,胸腔镜和腹腔镜亦被用于食管癌分期[13][14][15]。一项组间临床研究结果提示在107例可评估的患者中,若使用无创分期试验如CT、磁共振成像及EUS等,其阳性淋巴结的检出率为41%;若使用有创的胸腔镜/腹腔镜进行分期,该检测率可上升至56%,且无重大并发症或死亡[16] 。亦可使用核素标记的葡萄糖类似物18-氟脱氧右旋葡萄糖对食管癌进行术前分期;这一方法可能有助于发现IV期病变,而目前仍在临床评估阶段[17][18][19][20]

胃肠道间质瘤亦可发生于食管,常为良性。(更多信息请参考PDQ总结 胃肠道间质瘤的治疗​。)

相关总结

含食管癌相关信息的其他PDQ总结包括:

食管癌的预防​

食管癌的筛查​

参考文献

1. American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed January 10, 2014.

2. Devesa SS, Blot WJ, Fraumeni JF Jr: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83 (10): 2049-53, 1998.[PUBMED Abstract]

3. Blot WJ, McLaughlin JK: The changing epidemiology of esophageal cancer. Semin Oncol 26 (5 Suppl 15): 2-8, 1999.[PUBMED Abstract]

4. Lagergren J, Bergström R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340 (11): 825-31, 1999.[PUBMED Abstract]

5. Tietjen TG, Pasricha PJ, Kalloo AN: Management of malignant esophageal stricture with esophageal dilation and esophageal stents. Gastrointest Endosc Clin N Am 4 (4): 851-62, 1994.[PUBMED Abstract]

6. Lightdale CJ, Heier SK, Marcon NE, et al.: Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc 42 (6): 507-12, 1995.[PUBMED Abstract]

7. Kubba AK: Role of photodynamic therapy in the management of gastrointestinal cancer. Digestion 60 (1): 1-10, 1999 Jan-Feb.[PUBMED Abstract]

8. Heier SK, Heier LM: Tissue sensitizers. Gastrointest Endosc Clin N Am 4 (2): 327-52, 1994.[PUBMED Abstract]

9. Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable malignant dysphagia: initial and at death. Gastrointest Endosc 43 (1): 29-32, 1996.[PUBMED Abstract]

10. Ziegler K, Sanft C, Zeitz M, et al.: Evaluation of endosonography in TN staging of oesophageal cancer. Gut 32 (1): 16-20, 1991.[PUBMED Abstract]

11. Tio TL, Coene PP, den Hartog Jager FC, et al.: Preoperative TNM classification of esophageal carcinoma by endosonography. Hepatogastroenterology 37 (4): 376-81, 1990.[PUBMED Abstract]

12. Vazquez-Sequeiros E, Norton ID, Clain JE, et al.: Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc 53 (7): 751-7, 2001.[PUBMED Abstract]

13. Bonavina L, Incarbone R, Lattuada E, et al.: Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction. J Surg Oncol 65 (3): 171-4, 1997.[PUBMED Abstract]

14. Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and surgical therapy for esophageal cancer. Chest 107 (6 Suppl): 218S-223S, 1995.[PUBMED Abstract]

15. Luketich JD, Schauer P, Landreneau R, et al.: Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 114 (5): 817-21; discussion 821-3, 1997.[PUBMED Abstract]

16. Krasna MJ, Reed CE, Nedzwiecki D, et al.: CALGB 9380: a prospective trial of the feasibility of thoracoscopy/laparoscopy in staging esophageal cancer. Ann Thorac Surg 71 (4): 1073-9, 2001.[PUBMED Abstract]

17. Flamen P, Lerut A, Van Cutsem E, et al.: Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18 (18): 3202-10, 2000.[PUBMED Abstract]

18. Flamen P, Van Cutsem E, Lerut A, et al.: Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol 13 (3): 361-8, 2002.[PUBMED Abstract]

19. Weber WA, Ott K, Becker K, et al.: Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19 (12): 3058-65, 2001.[PUBMED Abstract]

20. van Westreenen HL, Westerterp M, Bossuyt PM, et al.: Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22 (18): 3805-12, 2004.[PUBMED Abstract]

下一页
译文由 中国国家癌症中心提供
本站由 中国医学科学院医学信息研究所创办并维护 未经许可禁止转载或建立镜像