Duhaylongsod F G, Wolfe W G
Department of General and Thoracic Surgery, Duke University, Durham, N.C.
J Thorac Cardiovasc Surg. 1991 Jul;102(1):36-41; discussion 41-2.
Since 1985, 57 patients with adenocarcinoma of the esophagus and gastroesophageal (GE) junction have undergone surgical resection. In this group, 16 of the tumors arose in a Barrett's esophagus. There was a significant predilection toward white men above the age of 55 (15/16; 94%) in this subgroup. The mean proximal extent of abnormal columnar involvement was 5.4 cm above the gastroesophageal junction (range 2.5 to 11 cm). The mean location of the neoplasm centered in the distal esophagus 1.8 +/- 0.5 cm above the gastroesophageal junction. During the same time period, 30 patients with Barrett's esophagus were seen without associated adenocarcinoma. There were no statistical differences in the proximal extent of columnar involvement or the presence of reflux symptoms between the two groups. There were no significant differences in age, smoking history, and alcohol consumption between patients with benign or malignant Barrett's esophagus as compared to those with adenocarcinoma of the gastroesophageal junction not associated with Barrett's mucosa. The marked male predominance seen in the group with malignant Barrett's esophagus was in contrast to the benign cases (16/30; 53%) but was similar to the adenocarcinoma group, without recognized Barrett's esophagus (38/41; 93%). The mean location of the tumor in the latter was 0.9 +/- 1.2 cm above the gastroesophageal junction and was comparable to the location in the group with Barrett's adenocarcinoma. The 4-year survival rate of patients in the non-Barrett's adenocarcinoma group is approximately 30%. Of those with Barrett's adenocarcinoma, the present 4-year survival rate is 60%. The demographic and morphometric similarities between the Barrett's and non-Barrett's adenocarcinoma groups may be of primary importance in determining the true clinical prevalence of Barrett's adenocarcinoma. Our findings suggest that the sensitivity of endoscopic surveillance may be improved if biopsy specimens are concentrated within the distal 3 cm of the esophagus and the esophagogastric junction. Finally, the reason for the current difference in survival between the Barrett's and non-Barrett's adenocarcinoma groups is uncertain but may be related to endoscopic surveillance permitting earlier diagnosis and treatment.
自1985年以来，57例食管腺癌和胃食管交界腺癌患者接受了手术切除。在这组患者中，16例肿瘤起源于巴雷特食管。在这个亚组中，55岁以上的白人男性有明显的偏好（16例中的15例；94%）。柱状上皮异常累及的平均近端范围是在胃食管交界上方5.4厘米（范围为2.5至11厘米）。肿瘤的平均位置以食管远端为中心，在胃食管交界上方1.8±0.5厘米处。在同一时期，发现30例巴雷特食管患者无相关腺癌。两组之间在柱状上皮累及的近端范围或反流症状的存在方面没有统计学差异。与无巴雷特黏膜的胃食管交界腺癌患者相比，良性或恶性巴雷特食管患者在年龄、吸烟史和饮酒量方面没有显著差异。恶性巴雷特食管组中明显的男性优势与良性病例形成对比（16/30；53%），但与无公认巴雷特食管的腺癌组相似（38/41；93%）。后者肿瘤的平均位置在胃食管交界上方0.9±1.2厘米处，与巴雷特腺癌组的位置相当。非巴雷特腺癌组患者的4年生存率约为30%。巴雷特腺癌患者目前的4年生存率为60%。巴雷特腺癌组和非巴雷特腺癌组在人口统计学和形态学上的相似性可能在确定巴雷特腺癌的真实临床患病率方面具有首要重要性。我们的研究结果表明，如果活检标本集中在食管远端3厘米和食管胃交界处，内镜监测的敏感性可能会提高。最后，巴雷特腺癌组和非巴雷特腺癌组目前生存率差异的原因尚不确定，但可能与内镜监测允许早期诊断和治疗有关。
