Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
Nat Rev Clin Oncol. 2023 Jun;20(6):390-407. doi: 10.1038/s41571-023-00757-y. Epub 2023 Apr 21.
The care of patients with oesophageal cancer or of individuals who have an elevated risk of oesophageal cancer has changed dramatically. The epidemiology of squamous cell and adenocarcinoma of the oesophagus has diverged over the past several decades, with a marked increase in incidence only for oesophageal adenocarcinoma. Only in the past decade, however, have molecular features that distinguish these two forms of the disease been identified. This advance has the potential to improve screening for oesophageal cancers through the development of novel minimally invasive diagnostic technologies predicated on cancer-specific genomic or epigenetic alterations. Surgical techniques have also evolved towards less invasive approaches associated with less morbidity, without compromising oncological outcomes. With improvements in multidisciplinary care, advances in radiotherapy and new tools to detect minimal residual disease, certain patients may no longer even require surgical tumour resection. However, perhaps the most anticipated advance in the treatment of patients with oesophageal cancer is the advent of immune-checkpoint inhibitors, which harness and enhance the host immune response against cancer. In this Review, we discuss all these advances in the management of oesophageal cancer, representing only the beginning of a transformation in our quest to improve patient outcomes.
食管癌患者或食管癌高危人群的护理发生了巨大变化。在过去几十年中，食管鳞癌和腺癌的流行病学特征已经出现了分歧，只有食管腺癌的发病率显著增加。然而，直到过去十年，才确定了区分这两种疾病形式的分子特征。这一进展有可能通过开发基于癌症特异性基因组或表观遗传改变的新型微创诊断技术来改善食管癌的筛查。手术技术也朝着创伤更小、发病率更低的方向发展，而不会影响肿瘤学结果。随着多学科护理的改善、放射治疗的进步和检测微小残留疾病的新工具的出现，某些患者甚至可能不再需要手术切除肿瘤。然而，在食管癌治疗方面最令人期待的进展可能是免疫检查点抑制剂的出现，它利用和增强了宿主对癌症的免疫反应。在这篇综述中，我们讨论了食管癌治疗方面的所有这些进展，这仅仅是我们提高患者治疗效果的努力的一个转变的开始。
