5 个北欧国家抗反流手术后的喉咽鳞状细胞癌。

Laryngeal and Pharyngeal Squamous Cell Carcinoma After Antireflux Surgery in the 5 Nordic Countries.

机构信息

Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.

出版信息

Ann Surg. 2022 Aug 1;276(2):e79-e85. doi: 10.1097/SLA.0000000000004423. Epub 2020 Oct 16.

DOI:10.1097/SLA.0000000000004423

PMID:33074906

Abstract

OBJECTIVE

The aim of this study was to clarify whether antireflux surgery prevents laryngeal and pharyngeal squamous cell carcinoma.

SUMMARY BACKGROUND DATA

Gastroesophageal reflux disease (GERD) seems to increase the risk of laryngeal and pharyngeal squamous cell carcinoma.

METHODS

All-Nordic (Denmark, Finland, Iceland, Norway, and Sweden) population-based cohort study of adults with documented GERD in 1980 to 2014. First, cancer risk after antireflux surgery was compared to the expected risk in the corresponding background population by calculating standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). Second, cancer risk among antireflux surgery patients was compared to nonoperated GERD patients using multivariable Cox regression, providing hazard ratios (HR) with 95% CIs, adjusted for sex, age, calendar period, and diagnoses related to tobacco smoking, obesity, and alcohol overconsumption.

RESULTS

Among 814,230 GERD patients, 47,016 (5.8%) underwent antireflux surgery. The overall SIRs and HRs of the combined outcome laryngeal or pharyngeal squamous cell carcinoma (n=39) were decreased after antireflux surgery [SIR=0.62 (95% CI 0.44-0.85) and HR=0.55 (95% CI 0.38-0.80)]. The point estimates were further decreased >10 years after antireflux surgery [SIR=0.48 (95% CI 0.26-0.80) and HR=0.47 (95% CI 0.26-0.85)]. The risk estimates of laryngeal squamous cell carcinoma were particularly decreased >10 years after antireflux surgery [SIR=0.28 (95% CI 0.08-0.72) and HR=0.23 (95% CI 0.08-0.69)], whereas no such decrease over time after surgery was found for pharyngeal squamous cell carcinoma. Analyses of patients with severe GERD (reflux esophagitis or Barrett esophagus) showed similar results.

CONCLUSION

Antireflux surgery may decrease the risk of laryngeal squamous cell carcinoma and possibly also of pharyngeal squamous cell carcinoma.

摘要

目的

本研究旨在阐明抗反流手术是否可预防喉和咽鳞癌。

背景资料概要

胃食管反流病（GERD）似乎会增加喉和咽鳞癌的风险。

方法

1980 年至 2014 年，对有记录的 GERD 的成年人进行了全北欧（丹麦、芬兰、冰岛、挪威和瑞典）基于人群的队列研究。首先，通过计算标准化发病比（SIR）及其 95%置信区间（CI），将抗反流手术后的癌症风险与相应背景人群的预期风险进行比较。其次，使用多变量 Cox 回归比较抗反流手术患者与未手术的 GERD 患者的癌症风险，提供调整性别、年龄、日历时间以及与吸烟、肥胖和过度饮酒相关的诊断后 95%CI 的风险比（HR）。

结果

在 814230 例 GERD 患者中，47016 例（5.8%）接受了抗反流手术。联合结局喉或咽鳞癌（n=39）的总体 SIR 和 HR 降低[SIR=0.62（95%CI 0.44-0.85）和 HR=0.55（95%CI 0.38-0.80)]。抗反流手术后 10 年以上的点估计值进一步降低[SIR=0.48（95%CI 0.26-0.80）和 HR=0.47（95%CI 0.26-0.85)]。抗反流手术后 10 年以上，喉鳞癌的风险估计值特别降低[SIR=0.28（95%CI 0.08-0.72）和 HR=0.23（95%CI 0.08-0.69)]，而手术后时间无明显变化。严重 GERD（反流性食管炎或 Barrett 食管）患者的分析结果相似。