Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Am J Gastroenterol. 2010 Oct;105(10):2144-9. doi: 10.1038/ajg.2010.263. Epub 2010 Jun 29.
Achalasia patients are considered at increased risk for esophageal cancer, but the reported relative risks vary. Identification of this risk is relevant for patient management. We performed a prospective evaluation of the esophageal cancer risk in a large cohort of achalasia patients with long-term follow-up.
Between 1975 and 2006, all patients diagnosed with primary achalasia in our hospital were treated and followed by the same protocol. After graded pneumatic dilatation, all patients were offered a fixed surveillance protocol including gastrointestinal endoscopy with esophageal biopsy sampling.
We surveyed a cohort of 448 achalasia patients (218 men, mean age 51 years at diagnosis, range 4-92 years) for a mean follow-up of 9.6 years (range 0.1-32). Overall, 15 (3.3%) patients (10 men) developed esophageal cancer (annual incidence 0.34 (95% confidence interval 0.20-0.56)). The mean age at cancer diagnosis was 71 years (range 36-90) after a mean of 11 years (range 2-23) following initial presentation, and a mean of 24 years (range 10-43) after symptom onset. The relative hazard rate of esophageal cancer was 28 (confidence interval 17-46) compared with an age- and sex-identical population in the same timeframe. Five patients received a potential curative treatment.
Although the gastro-esophageal cancer risk in patients with longstanding achalasia is much higher than in the general population, the absolute risk is rather low. Despite structured endoscopical surveillance, most neoplastic lesions remain undetected until an advanced stage. Efforts should be made to identify high-risk groups and develop adequate surveillance strategies.
贲门失弛缓症患者被认为患食管癌的风险增加，但报告的相对风险各不相同。识别这种风险与患者的管理有关。我们对一大组长期随访的贲门失弛缓症患者进行了前瞻性评估，以评估食管癌的风险。
1975 年至 2006 年期间，我院所有被诊断为原发性贲门失弛缓症的患者均采用相同的方案进行治疗和随访。在分级扩张后，所有患者均接受固定的监测方案，包括胃肠道内镜检查和食管活检取样。
我们对 448 名贲门失弛缓症患者（218 名男性，诊断时的平均年龄为 51 岁，范围为 4-92 岁）进行了平均随访 9.6 年（范围为 0.1-32 年）。总的来说，15 名（3.3%）患者（10 名男性）发生了食管癌（年发病率为 0.34%（95%置信区间为 0.20-0.56%））。诊断癌症的平均年龄为 71 岁（范围为 36-90 岁），在最初表现后平均 11 年（范围为 2-23 年），在症状出现后平均 24 年（范围为 10-43 年）。与同一时期年龄和性别相同的人群相比，食管癌的相对危险率为 28（置信区间为 17-46）。5 名患者接受了潜在的治愈治疗。
尽管长期贲门失弛缓症患者的胃食管癌症风险远高于一般人群，但绝对风险仍然较低。尽管进行了结构化的内镜监测，但大多数肿瘤病变仍未被发现，直到晚期。应努力确定高危人群并制定适当的监测策略。
