Ferguson Mark K, Durkin Amy
Department of Surgery, The University of Chicago, Chicago, IL 60637, USA.
J Gastrointest Surg. 2002 Jan-Feb;6(1):29-35; discussion 36. doi: 10.1016/s1091-255x(01)00052-x.
There is growing controversy over the cost-effectiveness of surveillance endoscopy for patients with Barrett's esophagus. A retrospective review was performed of 80 patients who underwent resection for Barrett's adenocarcinoma to assess the influence of endoscopic surveillance on long-term survival. Twelve patients initially were diagnosed with benign Barrett's esophagus and were followed with endoscopic surveillance. The remaining 68 patients had the diagnosis of Barrett's esophagus made at the time of their cancer diagnosis or resection. Patients in surveillance programs were younger (53 vs. 64 years; P = 0.008), had better performance status (8.9 vs. 8.2; P = 0.04), had less weight loss (0.3 vs. 5.5 kg; P < 0.001), had a similar incidence of gastroesophageal reflux disease symptoms (75% vs. 60%), and were less likely to undergo preoperative chemotherapy and/or radiation therapy (8% vs. 28%). Pathologic stage was 0 or I in 9 (75%) of 12 patients in the surveillance group compared to 12 (18%) of 68 of those in the no surveillance group (P < 0.001). Median survival for patients in the surveillance group was 107 months compared to 12 months for those in the no surveillance group (P < 0.001). Stratifying for stage, surveillance (hazard ratio = 3.05; confidence interval = 1.09 to 8.57; P = 0.034) was the only predictor of survival. Surveillance endoscopy permits early diagnosis of adenocarcinoma in patients with Barrett's esophagus and contributes substantially to long-term survival.
对于巴雷特食管患者，监测性内镜检查的成本效益存在越来越多的争议。对80例行巴雷特腺癌切除术的患者进行了回顾性研究，以评估内镜监测对长期生存的影响。12例患者最初被诊断为良性巴雷特食管，并接受内镜监测。其余68例患者在癌症诊断或切除时被诊断为巴雷特食管。接受监测计划的患者更年轻（53岁对64岁；P = 0.008），身体状况更好（8.9对8.2；P = 0.04），体重减轻更少（0.3千克对5.5千克；P < 0.001），胃食管反流病症状的发生率相似（75%对60%），且术前接受化疗和/或放疗的可能性更小（8%对28%）。监测组12例患者中有9例（75%）病理分期为0或I期，而未监测组68例患者中有12例（18%）（P < 0.001）。监测组患者的中位生存期为107个月，而未监测组为12个月（P < 0.001）。按分期分层后，监测（风险比 = 3.05；置信区间 = 1.09至8.57；P = 0.034）是生存的唯一预测因素。监测性内镜检查可使巴雷特食管患者的腺癌得到早期诊断，并对长期生存有很大贡献。
