Jankowski Meghan, Wani Sachin
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Curr Treat Options Gastroenterol. 2015 Mar;13(1):16-29. doi: 10.1007/s11938-014-0040-9.
Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC), a cancer that has increased in the Western world by nearly sixfold over the past three decades and is associated with a dismal 5-year survival rate (<20 %) especially when detected at a symptomatic state. Given the dramatic rise in EAC incidence and poor outcomes, much attention has focused on screening and surveillance in BE with a goal of identifying curable lesions and improving outcomes in patients with EAC. The limitations of current screening and surveillance strategies provide the necessary impetus to improve diagnostic accuracy and risk stratification of patients with BE. Biomarkers have the potential to predict risk of progression to cancer, identify patients most likely to respond to endoscopic eradication therapies, and ultimately influence patient management and outcomes. The goal of identifying such a biomarker or panel of biomarkers ready for clinical application remains elusive. This review highlights the recent advances in the field of biomarkers. It is increasingly being recognized that a single biomarker is suboptimal in accurate clinical risk stratification of individuals at highest risk for progression to cancer and an ideal risk stratification tool should include a panel of biomarkers in conjunction with clinical and endoscopic factors. Finally, we review advances in our screening strategies with use of Cytosponge, transnasal endoscopy, and tethered capsule endomicroscopy and surveillance strategies with use of advanced imaging techniques. Feasibility of these novel technologies for large population screening and surveillance needs to be assessed in future trials.
巴雷特食管（BE）是食管腺癌（EAC）公认的癌前病变，在过去三十年中，这种癌症在西方世界的发病率增加了近六倍，其5年生存率极低（<20%），尤其是在出现症状时才被发现。鉴于EAC发病率急剧上升且预后不佳，人们将大量注意力集中在BE的筛查和监测上，目标是识别可治愈的病变并改善EAC患者的预后。当前筛查和监测策略的局限性为提高BE患者的诊断准确性和风险分层提供了必要动力。生物标志物有潜力预测癌症进展风险，识别最可能对内窥镜根除治疗有反应的患者，并最终影响患者管理和预后。然而，找到一种可供临床应用的生物标志物或生物标志物组合的目标仍难以实现。本综述重点介绍了生物标志物领域的最新进展。越来越多的人认识到，单一生物标志物在对癌症进展风险最高的个体进行准确临床风险分层方面并不理想，理想的风险分层工具应包括一组生物标志物，并结合临床和内镜因素。最后，我们回顾了使用细胞海绵、经鼻内镜检查和系留胶囊内镜显微镜的筛查策略以及使用先进成像技术的监测策略方面的进展。这些新技术用于大规模人群筛查和监测的可行性需要在未来试验中进行评估。
