Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Gastroenterology. 2010 Apr;138(4):1297-301. doi: 10.1053/j.gastro.2010.01.004. Epub 2010 Jan 18.
BACKGROUND & AIMS: The question of a possible preventive effect of antireflux surgery on the development of esophageal or cardia adenocarcinoma remains unsettled. We aimed to clarify whether antireflux surgery prevents later development of esophageal adenocarcinoma.
We performed a Swedish population-based cohort study of antireflux surgery from 1965 to 2006. Follow-up evaluation for cancer and censoring for death and emigration were achieved up to December 31, 2006, through linkages to nationwide registers of cancer, population, and emigration. The cancer incidence in the antireflux surgery cohort was compared with that in the corresponding Swedish population. Relative risks were presented as standardized incidence ratios (SIRs), that is, the observed number of cancer cases in the antireflux surgery cohort divided by the expected number.
The antireflux surgery cohort comprised 14,102 persons, contributing 120,514 person-years at risk. Overall risk of esophageal adenocarcinoma (n = 39) was increased 12-fold (SIR, 12.3; 95% confidence interval [CI], 8.7-16.8). No risk decrease with time after antireflux surgery was found (P = .86). After a postsurgical follow-up evaluation of 15 years or more, the SIR was 14.6 (95% CI, 7.0-26.8). For the corresponding overall risk of cardia adenocarcinoma (n = 21) the SIR was 4.4 (95% CI, 2.7-6.7), without any major decrease in risk with time (P = .20); the SIR was 3.1 (95% CI, 0.6-9.1) after at least 15 years of follow-up evaluation. No association between antireflux surgery and gastric adenocarcinoma or esophageal squamous cell carcinoma was identified.
Antireflux surgery cannot be considered to prevent the development of esophageal or cardia adenocarcinoma among persons with reflux.
抗反流手术是否可能预防食管或贲门腺癌的发生仍存在争议。本研究旨在阐明抗反流手术是否能预防食管腺癌的发生。
我们进行了一项基于人群的瑞典队列研究，纳入了 1965 年至 2006 年期间进行的抗反流手术。通过与全国癌症、人群和移民登记处的链接，对截止至 2006 年 12 月 31 日的癌症发病情况和死亡及移民情况进行随访评估。将抗反流手术队列的癌症发病率与相应的瑞典人群进行比较。相对风险以标准化发病比（SIR）表示，即抗反流手术队列中的癌症病例数除以预期病例数。
抗反流手术队列包括 14102 例患者，共 120514 人年的风险暴露。（n = 39）食管腺癌的总体风险增加了 12 倍（SIR，12.3；95%可信区间[CI]，8.7-16.8）。未发现手术后时间与风险降低之间存在相关性（P =.86）。在抗反流手术后随访 15 年或更长时间后，SIR 为 14.6（95%CI，7.0-26.8）。对于相应的贲门腺癌总体风险（n = 21），SIR 为 4.4（95%CI，2.7-6.7），随着时间的推移风险无明显降低（P =.20）；至少随访 15 年后，SIR 为 3.1（95%CI，0.6-9.1）。未发现抗反流手术与胃腺癌或食管鳞癌之间存在关联。
抗反流手术不能被认为能预防反流患者发生食管或贲门腺癌。
