Kubba A K, Poole N A, Watson A
Department of Surgery, North Manchester General Hospital, University of Manchester, UK.
Dig Dis Sci. 1999 Apr;44(4):659-67. doi: 10.1023/a:1026608319881.
The risk of developing gastroesophageal adenocarcinoma is increased in patients with Barrett's esophagus. The management of dysplasia in Barrett's esophagus remains controversial. Understanding of the sequence of events preceding malignancy is essential before screening protocols for early diagnosis and preventive measures can be implemented. The aim of this review is to examine the published data on the role p53 assessment may play in the management of Barrett's esophagus. Relevant papers were identified by an extensive text word search of the Medline database and a review of quoted articles. The p53 abnormality occurs more frequently in highly dysplastic epithelium than in nondysplastic epithelium. However, the retrospective nature of most of the available data could be a significant confounding factor. Our current knowledge suggests that p53 protein overexpression does not seem to predict future progression to cancer or determine disease outcome. The p53 abnormality alone can not be reliably used to predict progression of Barrett's esophagus to cancer. We must await long-term evaluation of patients to determine the percentage of patients with p53 gene abnormality, and nondysplastic Barrett's who will progress to dysplasia or carcinoma. Large randomized controlled long-term follow-up studies are much needed.
巴雷特食管患者发生胃食管腺癌的风险增加。巴雷特食管发育异常的管理仍存在争议。在实施早期诊断筛查方案和预防措施之前，了解恶性肿瘤发生前的一系列事件至关重要。本综述的目的是研究已发表的关于p53评估在巴雷特食管管理中可能发挥的作用的数据。通过对Medline数据库进行广泛的文本词搜索以及对引用文章的回顾来识别相关论文。p53异常在高度发育异常的上皮中比在非发育异常的上皮中更频繁地发生。然而，大多数现有数据的回顾性性质可能是一个重大的混杂因素。我们目前的知识表明，p53蛋白过表达似乎不能预测未来是否会进展为癌症或决定疾病的结局。仅p53异常不能可靠地用于预测巴雷特食管向癌症的进展。我们必须等待对患者进行长期评估，以确定p53基因异常的患者以及非发育异常的巴雷特食管患者中将会进展为发育异常或癌症的患者百分比。非常需要进行大型随机对照长期随访研究。
