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《中国食管癌早期诊断与治疗专家共识》

[Chinese expert consensus on early diagnosis and treatment of esophageal cancer].

出版信息

Zhonghua Zhong Liu Za Zhi. 2022 Oct 23;44(10):1066-1075. doi: 10.3760/cma.j.cn112152-20220220-00114.

Abstract

Although the incidence rate of esophageal cancer in China is on the decline, China is still a high-incidence country of esophageal cancer with great regional variation. In recent years, the five-year survival of esophageal cancer in China has improved significantly. However, due to the absence of typical symptoms in early stage, there still exists a large esophageal cancer diagnostic yield gap between China and developed countries. At present, there are no international guidelines defining the target population for esophageal squamous cell carcinoma (ESCC) screening. Exploring and implementing effective esophageal cancer screening together with early diagnosis and early treatment are the keys to reducing the mortality and improving the survival rate and life quality. Endoscopic therapies, such as endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and radiofrequency ablation (RFA), are used to treat early-stage esophageal cancer. If the tumor invasion is deep or lymph node metastasis is suspected, surgery is needed, meanwhile radiation therapy could also be an optional treatment. Regular follow-up and surveillance are required for any strategy above to deal with relapse and metachronous primary cancers. The Early Diagnosis and Treatment Group of the Chinese Medical Association Oncology Branch has reached an expert consensus on screening and diagnostic protocols for esophageal cancer, on endoscopic and surgical treatment of early esophageal cancer and precancerous lesions, as well as on postoperative monitoring and adjuvant therapy. This consensus follows the evidence-based medicine at both domestic and international levels, combines the current clinical practice and application experience in the treatment of esophageal cancer in China, is based on a multidisciplinary treatment model, and can be used as a reference for clinicians.

摘要

尽管中国食管癌发病率呈下降趋势,但中国仍是食管癌高发国家,且地区差异极大。近年来,中国食管癌的五年生存率有了显著提高。然而,由于早期缺乏典型症状,中国与发达国家在食管癌诊断率方面仍存在较大差距。目前,尚无国际指南明确食管鳞状细胞癌(ESCC)筛查的目标人群。探索并实施有效的食管癌筛查以及早期诊断和早期治疗是降低死亡率、提高生存率和生活质量的关键。内镜治疗,如内镜黏膜下剥离术(ESD)、内镜黏膜切除术(EMR)和射频消融术(RFA),用于治疗早期食管癌。如果肿瘤侵犯较深或怀疑有淋巴结转移,则需要进行手术,同时放射治疗也可作为一种选择。上述任何一种策略都需要定期随访和监测,以应对复发和异时性原发性癌症。中华医学会肿瘤学分会早期诊断与治疗学组已就食管癌的筛查与诊断方案、早期食管癌及癌前病变的内镜和手术治疗以及术后监测与辅助治疗达成专家共识。该共识遵循国内外循证医学原则,结合了中国目前食管癌治疗的临床实践和应用经验,基于多学科治疗模式,可供临床医生参考。

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