感染与食管腺癌:综述及个人观点
infection and esophageal adenocarcinoma: a review and a personal view.
作者信息
Polyzos Stergios A, Zeglinas Christos, Artemaki Fotini, Doulberis Michael, Kazakos Evangelos, Katsinelos Panagiotis, Kountouras Jannis
机构信息
Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece.
出版信息
Ann Gastroenterol. 2018 Jan-Feb;31(1):8-13. doi: 10.20524/aog.2017.0213. Epub 2017 Nov 16.
Esophageal adenocarcinoma (EAC) is etiologically associated with gastroesophageal reflux disease (GERD). There is evidence to support the sequence GERD, Barrett's esophagus (BE), dysplasia, and finally EAC, with being implicated in each step to EAC. On the other side of this relation stands the hypothesis of the protective role of against EAC. Based on this controversy, our aim was to review the literature, specifically original clinical studies and meta-analyses linking infection with EAC, but also to provide our personal and others' relative views on this topic. From a total of 827 articles retrieved, 10 original clinical studies and 6 meta-analyses met the inclusion criteria. Original studies provided inconclusive data on an inverse or a neutral association between infection and EAC, whereas meta-analyses of observational studies favor an inverse association. Despite these data, we consider that the positive association between infection and GERD or BE, but not EAC, is seemingly a paradox. Likewise, the oncogenic effect of infection on gastric and colon cancer, but not on EAC, also seems to be a paradox. In this regard, well-designed prospective cohort studies with a powered sample size are required, in which potential confounders should be taken into consideration since their design.
食管腺癌(EAC)在病因上与胃食管反流病(GERD)相关。有证据支持GERD、巴雷特食管(BE)、发育异常,最终发展为EAC这一序列,且[此处原文缺失关键信息]在EAC发展的每一步中都有涉及。在这种关系的另一端,存在[此处原文缺失关键信息]对EAC具有保护作用的假说。基于这一争议,我们的目的是回顾文献,特别是将[此处原文缺失关键信息]感染与EAC联系起来的原始临床研究和荟萃分析,同时也提供我们个人以及其他人关于该主题的相关观点。在总共检索到的827篇文章中,有10项原始临床研究和6项荟萃分析符合纳入标准。原始研究提供的数据对于[此处原文缺失关键信息]感染与EAC之间的负相关或中性关联尚无定论,而观察性研究的荟萃分析则倾向于负相关。尽管有这些数据,但我们认为[此处原文缺失关键信息]感染与GERD或BE之间的正相关,而非与EAC之间的正相关,似乎是一个悖论。同样,[此处原文缺失关键信息]感染对胃癌和结肠癌有致癌作用,但对EAC没有,这似乎也是一个悖论。在这方面,需要设计良好且样本量充足的前瞻性队列研究,从研究设计开始就应考虑潜在的混杂因素。
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