Vats Hemender S, Banerjee Tarit K, Resnick Jeffrey, Khan Qaseem
Department of General Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
Clin Med Res. 2006 Sep;4(3):184-8. doi: 10.3121/cmr.4.3.184.
A relatively young patient with chronic gastroesophageal reflux disease (GERD), obesity, smoking, and alcohol intake presented with widespread metastatic disease in lymph nodes, liver and lungs from a lower esophageal adenocarcinoma extending into the gastroesophageal junction associated with Barrett's mucosa and dysplasia.A complete response was achieved with six cycles of chemotherapy that sustained for more than 4 years without further recurrence. Unfortunately, there was presence of esophageal metaplasia after complete response which eventually converted to low to high grade dysplasia and ultimately to a second primary localized lower esophageal adenocarcinoma that was treated with thoracoabdominal esophagectomy and lymphadenectomy. No evidence of disease recurrence was seen 2 years later. The pathogenesis of a recent increase in the incidence of GERD, Barrett's esophagus and lower esophageal adenocarcinoma are discussed. Surgery, radiotherapy and combination chemotherapy are effective in the early stages leading to tumor shrinkage and prolongation of life and even cure in some cases. Lower esophageal adenocarcinoma is frequently associated with Barrett's high-grade dysplasia. Since there has been a dramatic increase in the incidence of Barrett's dysplasia, appropriate surveillance with upper gastrointestinal endoscopy and preventive strategies, such as the use of aspirin, cyclo-oxygenase II inhibitors and other nonsteroidal antiinflammatory drugs known to be chemopreventive agents against colon, esophagus, gastric and bladder cancers, need to be studied.
一名相对年轻的慢性胃食管反流病（GERD）患者，伴有肥胖、吸烟和饮酒史，因下食管腺癌延伸至胃食管交界处并伴有巴雷特黏膜和发育异常，出现了广泛的淋巴结、肝脏和肺部转移。通过六个周期的化疗实现了完全缓解，缓解持续了四年多且无进一步复发。不幸的是，完全缓解后出现了食管化生，最终转变为低级别至高级别发育异常，并最终发展为第二原发性局限性下食管腺癌，接受了胸腹联合食管切除术和淋巴结清扫术。两年后未见疾病复发迹象。文中讨论了近期GERD、巴雷特食管和下食管腺癌发病率上升的发病机制。手术、放疗和联合化疗在早期有效，可导致肿瘤缩小、延长生命，甚至在某些情况下实现治愈。下食管腺癌常与巴雷特高级别发育异常相关。由于巴雷特发育异常的发病率急剧上升，需要研究通过上消化道内镜进行适当监测以及采取预防策略，如使用阿司匹林、环氧化酶II抑制剂和其他已知对结肠癌、食管癌、胃癌和膀胱癌具有化学预防作用的非甾体抗炎药。
