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盘点：食管癌近期研究进展汇总

2018-06-30 MedSci MedSci原创

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【1】中国内镜筛查食管癌的效果分析近日，ESECC试验公布了中国食管癌内镜筛查（ESECC）项目的基线招募和筛查设计和初步结果。研究以中国河南省食管鳞癌高发病率地区的668个村为基础，这些村以1:1的比例被随机分成两组。筛查组的参与者进行碘染色内镜检查；对照组未进行内镜筛选。2012年1月到2016年9月期间分别有17151名和16797名参与者被招募入筛查组和对照组。食管和整体上消化道高级别病变

【1】中国内镜筛查食管癌的效果分析

近日，ESECC试验公布了中国食管癌内镜筛查（ESECC）项目的基线招募和筛查设计和初步结果。研究以中国河南省食管鳞癌高发病率地区的668个村为基础，这些村以1:1的比例被随机分成两组。筛查组的参与者进行碘染色内镜检查；对照组未进行内镜筛选。2012年1月到2016年9月期间分别有17151名和16797名参与者被招募入筛查组和对照组。食管和整体上消化道高级别病变的患病率（45-69岁）分别为744.0/100000和902.0/100000。113例高级别食管病变患者中的69.9%为病变早期。严重食管发育不良和更严重病变的危险因素包括：年龄较大、食管癌家族史、体重指数较低、进食迅速和频繁地摄入剩菜。

【2】饮用热茶及其与酒精和烟酒相互作用对食管癌风险的影响

尽管在高温下饮茶已被认为是食管癌的危险因素，但一直没有观察到这种相关性，并且这种相关性是否独立于酒精和烟草暴露尚不明确。近日，一项前瞻性研究评估了高温饮茶，连同饮酒和吸烟危险因素，是否与食管癌风险有关。参与者为456155名30至79岁的个体，那些在基线时患有癌症或在基线之前减少饮茶、饮酒或烟草的个体被排除在外。研究指标包括饮茶时的一般温度，其他茶叶消耗指标和生活方式行为，结局为截止至2015年食管癌发病率。结果表明，高温饮茶与饮酒或吸烟相结合所致的食管癌风险高于单独饮用热茶。与不是每周喝茶以及每日饮酒少于15克的人群相比，每日饮热茶和每日饮酒15克以上的患者发生食管癌的风险最高。同样地，每天饮热茶的吸烟者发生食管癌的HR为2.03。由此可见，在高温下喝茶与过量饮酒或吸烟相结合会导致食道癌风险增加。

【3】SHR-1210治疗晚期食管癌的安全性、有效性及生物学标志

目前对晚期食管鳞状细胞癌的治疗依然未取得令人满意的效果。SHR-1210是一种选择性的高度亲和力的PD-1单抗。新的一项研究探究了SHR-1210治疗复发或转移食管鳞状细胞癌患者的安全性、有效性和生物学标志。研究共纳入30例患者，10例患者出现客观有效。中位无进展生存期3.6个月。出现3例治疗相关3级不良反应：2例肺炎以及1例肌钙蛋白升高。未发现治疗相关4或5级不良反应。外显子测序分析表明突变负荷以及潜在的突变相关新抗原数量与更好的治疗反应相关。PD-L1阳性肿瘤比PD-L1阴性肿瘤客观有效率更高。文章最后认为，SHR-1210治疗食管鳞状细胞癌患者具有可控的安全性及有效的抗肿瘤活性。

【4】鳞状细胞癌抗原血清测定可以作为Barrett食管和食管癌的生物标记物

目前Barrett食管（BE）的监测成本高居不下，仍然是临床难点之一，学界仍然不推荐在筛查和监测中使用生物标志物。因此为了评价鳞状细胞癌抗原的免疫复合形式的确定的潜在作用SCCA-immunoglobulin（Ig）作为筛选Barrett食管（BE）和食管腺癌（EAC）可行性进行了本项研究。研究共招募231名患者，BE患者71名，EAC患者53名，107名对照者测定他们的SCCA-IgM水平。通过受试者工作特征曲线计算BE / EAC与对照之间的SCCA-IgM截止值。结果显示，BE和EAC的中位SCCA-IgM值显着高于对照组。SCCA-IgM水平高于临界值的患者携带BE或EAC的相对风险高33倍。患有“有风险”的患者，伴有长或不典型BE的患者SCCA-IgM水平显着高于非短暂性不典型BE患者，SCCA-IgM高于截断患者的BE患者的相对风险高8倍风险。

【5】新辅助放化疗治疗食管癌后，内镜超声、活检、PET-CT等方法检测残余病灶的漏诊情况

近日，Lancet子刊上发表一篇文章，对比新辅助放化疗后，用不同的诊断方法检测残余病灶的准确性，并探究进行临床反应评估的诊断技术的最佳组合。研究招募年满18岁的组织学确诊的可切除的食管或胃食管交界鳞状细胞癌或腺癌患者，并可进行新辅助放化疗，随后进行食管切除术。研究共招募219位患者，其中207位纳入分析。以内镜常规活检检查漏诊8位TRG3或TRG4期肿瘤患者。以点对点活检和细针穿刺淋巴结漏诊4例TRG3或TRG4肿瘤。内镜超声测量最大肿瘤厚度漏诊11位RG3或TRG4残余肿瘤患者。PET-CT漏诊6例TRG3或TRG4肿瘤。PET-CT在190位患者中检测出18例（9%）经组织学证实的间隔转移癌。对食管癌进行新辅助放化疗后，用内镜超声、点对点活检和细针穿刺可疑淋巴结进行临床反应评估足够检测出局部残余病灶，用PET-CT可检测间隔转移。

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    2018-08-05 衣觉

    浪险浪险

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    2018-07-02 mashirong

    #研究进展#

    0

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    2018-07-02 zhouqu_8

    #食管#

    0

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    2018-07-02 jihuaijun1112

    学习学习学习

    0

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    2018-07-01 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-07-01 jihuaijun1112

    学习学习学习

    0

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    2018-07-01 jihuaijun1112

    学习学习学习

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    2018-06-30 清风拂面

    谢谢分享学习

    0