Yokoyama A, Ohmori T, Makuuchi H, Maruyama K, Okuyama K, Takahashi H, Yokoyama T, Yoshino K, Hayashida M, Ishii H
National Institute on Alcoholism, Kurihama National Hospital, Kanagawa, Japan.
Cancer. 1995 Sep 15;76(6):928-34. doi: 10.1002/1097-0142(19950915)76:6<928::aid-cncr2820760604>3.0.co;2-5.
Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers.
A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes.
Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively).
Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.
流行病学研究已提供证据表明，酗酒是食管癌的一个重要危险因素。然而，尚未建立针对重度饮酒高危人群进行食管癌早期检测的系统筛查项目。
在日本神奈川县国立酒精中毒研究所，对629名男性酗酒者（年龄54±8岁）进行连续系统的内镜检查，同时结合碘染色和靶向活检。对于黏膜癌，采用内镜下食管黏膜切除术（EEMR）进行确诊和治疗。
162例患者（25.8%）的食管壁上观察到碘不着色病变，边界清晰、呈白色，最大直径5毫米或更大。在629例患者中的21例出现了36个此类不着色病变，其意外地高达3.3%的比例被证实为浅表型鳞状细胞癌。根据一些既定标准，其中17例患者接受了EEMR，其中3例还接受了额外的放疗。2例患者接受了食管切除术，1例接受了化疗联合放疗，而另1例则接受内镜随访。8例患者的癌浸润局限于上皮层，9例局限于固有黏膜层，4例局限于黏膜下层。多元逻辑回归显示，与低度酒精饮料（如清酒或啤酒）相比，饮用烈性酒精饮料（如威士忌或烧酒）的人群出现明显碘不着色病变和浅表食管癌的风险独立增加（优势比[OR]分别为1.47和2.94），且每天吸烟30支以上的人群风险也增加（OR分别为1.68和3.85）。
对这些高危个体常规应用该筛查项目，食管癌的检出率异常高。
