Labenz Joachim, Koop Herbert, Tannapfel Andrea, Kiesslich Ralf, Hölscher Arnulf H
Department of Internal Medicine and Gastroenterology, Diakonie Klinikum, Jung-Stilling Hospital, Siegen, Department of General Practice, Internal Medicine and Gastroenterology, HELIOS Hospital Berlin-Buch, Institute of Pathology, Ruhr-University Bochum, Dr.-Horst-Schmidt-Kliniken, Wiesbaden, Department of General, Visceral and Cancer Surgery, University of Cologne.
Dtsch Arztebl Int. 2015 Mar 27;112(13):224-33; quiz 234. doi: 10.3238/arztebl.2015.0224.
Roughly 3000 new cases of Barrett's carcinoma arise in Germany each year. In view of recent advances in the epidemiology, diagnosis, and treatment of this disease, an update of the clinical recommendations is in order.
This review is based on selected relevant publications, including current reviews, meta-analyses, and guidelines.
The risk of progression of Barrett's esophagus to carcinoma lies between 0.10% and 0.15% per year. Risk factors for progression include male sex, age over 50 years, obesity, longstanding and frequent reflux symptoms, smoking, length of the Barrett's esophagus, and intraepithelial neoplasia. Well-differentiated carcinomas that are confined to the esophageal mucosa can be resected endoscopically with a cure rate above 90%. For more advanced, but still locally confined tumors, surgical resection is the treatment of choice. In stages cT3/4, the prognosis can be improved with neo-adjuvant chemo - therapy or combined radiotherapy and chemotherapy. Metastatic Barrett's carcinoma can be treated by endoscopic, chemotherapeutic, radiotherapeutic, and palliative methods.
Early carcinoma can often be cured by endoscopic resection. Locally advanced carcinoma calls for multimodal treatment. Current research focuses on means of preventing the progression of Barrett's esophagus, the scope of applicability of endoscopic techniques, and the optimization of multimodal treatment strategies for advanced disease.
德国每年约有3000例新发巴雷特食管癌病例。鉴于该疾病在流行病学、诊断和治疗方面的最新进展，有必要更新临床建议。
本综述基于精选的相关出版物，包括当前的综述、荟萃分析和指南。
巴雷特食管进展为癌的风险为每年0.10%至0.15%。进展的风险因素包括男性、年龄超过50岁、肥胖、长期频繁的反流症状、吸烟、巴雷特食管的长度以及上皮内瘤变。局限于食管黏膜的高分化癌可通过内镜切除，治愈率超过90%。对于更晚期但仍局限于局部的肿瘤，手术切除是首选治疗方法。在cT3/4期，新辅助化疗或放化疗联合可改善预后。转移性巴雷特癌可通过内镜、化疗、放疗和姑息治疗方法进行治疗。
早期癌通常可通过内镜切除治愈。局部晚期癌需要多模式治疗。当前的研究重点在于预防巴雷特食管进展的方法、内镜技术的适用范围以及晚期疾病多模式治疗策略的优化。
