Eckardt V F, Kanzler G, Bernhard G
Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
Am J Med. 2001 Jul;111(1):33-7. doi: 10.1016/s0002-9343(01)00745-8.
It has been suggested that patients with Barrett's esophagus have a substantially increased risk of esophageal and possibly extra-esophageal cancers. We compared the incidence of cancer and the survival rates of patients with Barrett's esophagus with those observed in patients with achalasia, with Schatzki's ring, and in the general population.
From 1980 through 1994, 60 consecutive patients with newly diagnosed long-segment Barrett's esophagus without dysplasia were seen in a single gastroenterology consultation office and followed until the Fall of 1999. Cancer incidence and survival rates were compared with age- and sex-matched patients with symptomatic Schatzki's ring (n = 60) and achalasia (n = 60). Survival data were also compared with those of the German population.
During a mean (+/-SD) observation period of 10 +/- 5 years, 2 patients with Barrett's esophagus (3%; 95% confidence interval [CI]: 0% to 11%) developed esophageal cancer, and 9 (15%; 95% CI: 7% to 27%) developed extra-esophageal cancers. These data differed only slightly from those of patients with Schatzki's ring (esophageal cancer: n = 1, 2%; 95% CI: 0% to 9%; extra-esophageal cancers: n = 9, 15%; 95% CI: 7%-27%) and achalasia (no esophageal cancers, extra-esophageal cancers: n = 3, 5%; 95% CI: 1% to 4%). Estimated 10-year survival was similar in patients with Barrett's esophagus (83%), patients with symptomatic Schatzki's ring (80%), patients with achalasia (87%), and in the general population (82%).
The cancer risk in patients with Barrett's esophagus has been overestimated. If patients with nondysplastic epithelium are followed, the risk of esophageal cancer is about 1 per 300 patient-years.
有研究表明，巴雷特食管患者患食管癌以及可能的食管外癌症的风险大幅增加。我们比较了巴雷特食管患者的癌症发病率和生存率与贲门失弛缓症患者、有沙茨基环患者以及普通人群的情况。
1980年至1994年期间，在一家胃肠病咨询诊所连续诊治了60例新诊断的无发育异常的长段巴雷特食管患者，并随访至1999年秋季。将癌症发病率和生存率与年龄和性别匹配的有症状沙茨基环患者（n = 60）和贲门失弛缓症患者（n = 60）进行比较。生存数据也与德国人群的数据进行了比较。
在平均（±标准差）10±5年的观察期内，2例巴雷特食管患者（3%；95%置信区间[CI]：0%至11%）发生了食管癌，9例（15%；95% CI：7%至27%）发生了食管外癌症。这些数据与有沙茨基环患者（食管癌：n = 1，2%；95% CI：0%至9%；食管外癌症：n = 9，15%；95% CI：7%至27%）和贲门失弛缓症患者（无食管癌，食管外癌症：n = 3，5%；95% CI：1%至4%）的数据仅略有差异。巴雷特食管患者、有症状沙茨基环患者、贲门失弛缓症患者和普通人群的估计10年生存率相似（分别为83%、80%、87%和82%）。
巴雷特食管患者的癌症风险被高估了。如果对无发育异常上皮患者进行随访，食管癌风险约为每300患者年1例。
