Watanabe Masayuki
Department of Gastroenterological Surgery, the Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
JMA J. 2018 Sep 28;1(1):30-39. doi: 10.31662/jmaj.2018-0002.
Despite recent advances in multidisciplinary treatment strategy, outcomes of esophageal cancer treatment still remain unsatisfactory. There are two histologic subtypes of esophageal cancer, namely, squamous cell carcinoma and adenocarcinoma, and these subtypes turned out to be genetically separate diseases. I focused on nine topics among the cancer's epidemiology, diagnosis, and treatment, and reviewed the literature. Although the number of patients with esophageal cancer has been continuously increasing, the cause of esophageal cancer is evident in a substantial proportion of patients, and public education may be able to decrease its incidence. Early detection and less invasive treatment will improve the outcome of patients. Minimally invasive esophagectomy decreased surgical invasiveness and improved short-term outcomes in the clinical trials. Centralization of patients to high-volume centers and introduction of multidisciplinary perioperative care bundle may further improve the outcome of patients undergoing esophagectomy. Although no targeting agent has shown efficacy in patients with esophageal cancer, immune checkpoint blockades are promising, and the results of phase III trials are awaited.
尽管多学科治疗策略最近取得了进展，但食管癌的治疗效果仍然不尽人意。食管癌有两种组织学亚型，即鳞状细胞癌和腺癌，事实证明这些亚型是基因上不同的疾病。我聚焦于癌症的流行病学、诊断和治疗中的九个主题，并对文献进行了综述。尽管食管癌患者数量一直在持续增加，但相当一部分患者的食管癌病因是明确的，公众教育或许能够降低其发病率。早期检测和侵入性较小的治疗将改善患者的治疗效果。在临床试验中，微创食管切除术降低了手术创伤并改善了短期疗效。将患者集中到高容量中心并引入多学科围手术期护理方案可能会进一步改善接受食管切除术患者的治疗效果。尽管尚无靶向药物在食管癌患者中显示出疗效，但免疫检查点阻断疗法很有前景，目前正在等待III期试验的结果。
