Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK.
BMJ. 2024 Jun 3;385:e074962. doi: 10.1136/bmj-2023-074962.
Esophageal cancer is the seventh most common malignancy worldwide, with over 470 000 new cases diagnosed each year. Two distinct histological subtypes predominate, and should be considered biologically separate disease entities.1 These subtypes are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Outcomes remain poor regardless of subtype, with most patients presenting with late stage disease.2 Novel strategies to improve early detection of the respective precursor lesions, squamous dysplasia, and Barrett's esophagus offer the potential to improve outcomes. The introduction of a limited number of biologic agents, as well as immune checkpoint inhibitors, is resulting in improvements in the systemic treatment of locally advanced and metastatic esophageal cancer. These developments, coupled with improvements in minimally invasive surgical and endoscopic treatment approaches, as well as adaptive and precision radiotherapy technologies, offer the potential to improve outcomes still further. This review summarizes the latest advances in the diagnosis and management of esophageal cancer, and the developments in understanding of the biology of this disease.
食管癌是全球第七大常见恶性肿瘤，每年新诊断病例超过 47 万例。两种不同的组织学亚型占主导地位，应被视为生物学上独立的疾病实体。1 这些亚型是食管腺癌（EAC）和食管鳞状细胞癌（ESCC）。无论亚型如何，预后仍然较差，大多数患者就诊时已处于晚期疾病。2 为改善各自的癌前病变、鳞状上皮不典型增生和 Barrett 食管的早期检测，提出了一些新的策略，有可能改善预后。有限数量的生物制剂和免疫检查点抑制剂的引入，正在导致局部晚期和转移性食管癌的系统治疗取得改善。这些发展，加上微创外科和内镜治疗方法的改进，以及适应性和精确放疗技术的发展，有可能进一步改善预后。本文综述了食管癌的诊断和治疗的最新进展，以及对这种疾病生物学的理解的发展。
