Krishnadath K K, Reid B J, Wang K K
Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2001 Apr;76(4):438-46. doi: 10.4065/76.4.438.
Barrett esophagus is a premalignant condition that may progress to adenocarcinoma. The risk of developing cancer has been estimated to be approximately 1 in 250 patient-years of observation; however, there appear to be subsets of patients at much higher risk. Risk stratification has previously been determined by histological identification of dysplasia. Several new biomarkers are being tested to help clinicians better determine the risk of cancer development. Although none of these biomarkers has been proven in a prospective study to predict the onset of cancer, they have been correlated with cancer development. Most of these are factors that have been associated with cancer development in other organs. These include assessment of cell proliferation, expression of cyclooxygenase 2, growth factors and oncogenes, secretory factors, cell cycle proteins, adhesion molecules, and aneuploidy and other genetic abnormalities. In addition to their role as potential cancer biomarkers, these factors have increasingly been reported as surrogate markers to monitor the effectiveness of conservative treatments for Barrett esophagus. In this article, biological markers are reviewed for their relevance in Barrett esophagus. Although most biological markers need to be evaluated further and, for most, prospective follow-up studies are lacking, at present abnormal ploidy status, P16 and P53 gene abnormalities, or allelic losses are the most extensively documented.
巴雷特食管是一种癌前病变，可能会发展为腺癌。据估计，在观察的患者年数中，患癌风险约为1/250；然而，似乎有一部分患者的风险要高得多。此前，风险分层是通过发育异常的组织学鉴定来确定的。目前正在测试几种新的生物标志物，以帮助临床医生更好地确定癌症发生的风险。尽管这些生物标志物中没有一种在前瞻性研究中被证明可以预测癌症的发生，但它们与癌症的发展相关。其中大多数是与其他器官癌症发展相关的因素。这些因素包括细胞增殖评估、环氧合酶2、生长因子和癌基因的表达、分泌因子、细胞周期蛋白、黏附分子，以及非整倍体和其他基因异常。除了作为潜在的癌症生物标志物的作用外，这些因素越来越多地被报道为监测巴雷特食管保守治疗效果的替代标志物。在本文中，将对生物标志物在巴雷特食管中的相关性进行综述。尽管大多数生物标志物需要进一步评估，而且大多数缺乏前瞻性随访研究，但目前非整倍体状态异常、P16和P53基因异常或等位基因缺失是记录最广泛的。
