Tustumi F, Bernardo W M, da Rocha J R M, Szachnowicz S, Seguro F C, Bianchi E T, Sallum R A A, Cecconello I
Dis Esophagus. 2017 Oct 1;30(10):1-8. doi: 10.1093/dote/dox072.
Achalasia of the cardia is associated with an increased risk of esophageal carcinoma. The real burden of achalasia at the malignancy genesis is still a controversial issue. Therefore, there are no generally accepted recommendations on follow-up evaluation for achalasia patients. This study aims to estimate the risk of esophageal adenocarcinoma and squamous cell carcinoma in achalasia patients. We searched for association between carcinoma and esophageal achalasia in databases up to January 2017 to perform a systematic review and meta-analysis. A total of 1,046 studies were identified from search strategy, of which 40 were selected for meta-analysis. A cumulative number of 11,978 esophageal achalasia patients were evaluated. The incidence of squamous cell carcinoma was 312.4 (StDev 429.16) cases per 100,000 patient-years at risk. The incidence of adenocarcinoma was 21.23 (StDev 31.6) cases per 100,000 patient-years at risk. The prevalence for esophageal carcinoma was 28 carcinoma cases in 1,000 esophageal achalasia patients (CI 95% 2, 39). The prevalence for squamous cell carcinoma was 26 cases in 1,000 achalasia patients (CI 95% 18, 39) and for adenocarcinoma was 4 cases in 1,000 achalasia patients (CI 95% 3, 6).The absolute risk increase for squamous cell carcinoma was 308.1 and for adenocarcinoma was 18.03 cases per 100,000 patients per year. To the best of our knowledge, this is the first meta-analysis estimating the burden of achalasia as an esophageal cancer risk factor. The high increased risk rate for cancer in achalasia patients points to a strict endoscopic surveillance for these patients. Also, the increased risk for developing adenocarcinoma in achalasia patients suggests fundoplication after myotomy, to avoid esophageal reflux and Barret esophagus, a known risk factor for adenocarcinoma.
贲门失弛缓症与食管癌风险增加相关。贲门失弛缓症在恶性肿瘤发生过程中的实际负担仍是一个有争议的问题。因此，对于贲门失弛缓症患者的随访评估尚无普遍接受的建议。本研究旨在评估贲门失弛缓症患者发生食管腺癌和鳞状细胞癌的风险。我们在截至2017年1月的数据库中搜索癌症与食管贲门失弛缓症之间的关联，以进行系统评价和荟萃分析。通过检索策略共识别出1046项研究，其中40项被选入荟萃分析。总共评估了11978例食管贲门失弛缓症患者。鳞状细胞癌的发病率为每100,000患者-年风险中有312.4（标准差429.16）例。腺癌的发病率为每100,000患者-年风险中有21.23（标准差31.6）例。食管癌在每1000例食管贲门失弛缓症患者中的患病率为28例（95%置信区间2，39）。鳞状细胞癌在每1000例贲门失弛缓症患者中的患病率为26例（95%置信区间18，39），腺癌在每1000例贲门失弛缓症患者中的患病率为4例（95%置信区间3，6）。鳞状细胞癌的绝对风险增加为每100,000患者每年308.1例，腺癌为18.03例。据我们所知，这是第一项评估贲门失弛缓症作为食管癌危险因素负担的荟萃分析。贲门失弛缓症患者癌症风险的高增长率表明应对这些患者进行严格的内镜监测。此外，贲门失弛缓症患者发生腺癌风险的增加表明在肌切开术后应行胃底折叠术，以避免食管反流和巴雷特食管，后者是腺癌的已知危险因素。
