Lagergren Jesper
Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, SE-171 76 Stockholm, Sweden.
Best Pract Res Clin Gastroenterol. 2006;20(5):803-12. doi: 10.1016/j.bpg.2006.04.009.
The rapid increase in the incidence of oesophageal adenocarcinoma, particularly among white males, seems to be a true increase occurring in many parts of the industrialised world during the last few decades. Some main risk factors have been established: i.e. Barrett's oesophagus, gastrooesophageal reflux, high body mass, male sex, tobacco smoking, and high dietary intake of fruit and vegetables. Several other potential risk factors have been studied for which the evidence is less clear, including medications that relax the lower oesophageal sphincter or diets high in fat or low in nutrients from plant foods. Other factors have been found to be possibly inversely linked with the risk of oesophageal adenocarcinoma, including infection with Helicobacter pylori and anti-inflammatory drugs (such as aspirin and other non-steroidal anti-inflammatory drugs, including cyclo-oxygenase inhibitors). The methodological problem of 'confounding by indication' makes it difficult to interpret the results of anti-inflammatory drugs, and currently such medication cannot be recommended for the prevention of oesophageal adenocarcinoma. Similarly, since there is no strong evidence of a preventive effect of medical or surgical antireflux therapy with regard to risk of oesophageal adenocarcinoma, such therapy cannot be recommended in the prevention of this cancer. Although some of the known risk factors might contribute to the increasing incidence of oesophageal adenocarcinoma, the explanation that can entirely explain this striking trend remains to be identified. Oesophageal adenocarcinoma is a highly deadly cancer, but the overall prognosis and the prognosis after oesophageal cancer surgery has improved during recent years.
食管腺癌的发病率迅速上升，尤其是在白人男性中，这似乎是过去几十年来工业化世界许多地区真实出现的增长。一些主要风险因素已被确定，即巴雷特食管、胃食管反流、高体重、男性、吸烟以及水果和蔬菜的高膳食摄入量。还对其他几个潜在风险因素进行了研究，但其证据不太明确，包括使食管下括约肌松弛的药物或高脂肪或植物性食物营养成分低的饮食。已发现其他一些因素可能与食管腺癌风险呈负相关，包括幽门螺杆菌感染和抗炎药物（如阿司匹林及其他非甾体抗炎药，包括环氧化酶抑制剂）。“指征性混杂”的方法学问题使得难以解释抗炎药物的结果，目前不推荐此类药物用于预防食管腺癌。同样，由于没有强有力的证据表明药物或手术抗反流治疗对食管腺癌风险有预防作用，因此不推荐这种治疗用于预防该癌症。尽管一些已知风险因素可能导致食管腺癌发病率上升，但能完全解释这一显著趋势的原因仍有待确定。食管腺癌是一种高度致命的癌症，但近年来总体预后以及食管癌手术后的预后有所改善。
