Birgisson S, Rice T W, Easley K A, Richter J E
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Gastroenterol. 1997 Feb;92(2):216-21.
The cause of the rapid increase in the incidence of adenocarcinoma of the esophagus since the 1970s is unknown.
To test the hypothesis that duodenogastroesophageal reflux causes adenocarcinoma of the esophagus by comparing the frequency of gastric surgery (a human model of duodenogastroesophageal reflux) and other potential risk factors between patients with adenocarcinoma and patients with squamous cell carcinoma of the esophagus.
Medical records of all patients with adenocarcinoma or squamous cell carcinoma of the esophagus seen at the Cleveland Clinic Foundation between 1987 and 1994 were reviewed. The following data were retrieved: age, gender, race, tumor location, history of gastric surgery and gastroesophageal reflux symptoms, and use of tobacco, alcohol, histamine-2 receptor antagonists, and proton pump inhibitors.
The data of 325 patients with adenocarcinoma (73.5%) and 117 patients with squamous cell carcinoma (26.5%) were analyzed. No differences were found between the groups in age, proportion with gastric surgery (patients with adenocarcinoma: 1.2%, 95% confidence interval 0.3-3.1%; patients with squamous cell carcinoma: 0.9%, 95% confidence interval 0.0-4.7%), smoking (76.7 vs 81.6%), or alcohol use (71.8 vs 79.1%). Significant risk factors associated with adenocarcinoma of the esophagus were male gender, white race, distal cancer location, and Barrett's esophagus.
Previous gastric surgery is rarely found in patients with esophageal cancer and is performed with equal frequency in patients with adenocarcinoma and those with squamous cell carcinoma of the esophagus. This suggests that gastric surgery and its associated duodenogastroesophageal reflux do not play a role in the etiology and rising incidence of adenocarcinoma of the esophagus. White males in their mid-60s with Barrett's esophagus who smoke and drink alcohol are at highest risk for adenocarcinoma of the esophagus.
自20世纪70年代以来，食管腺癌发病率迅速上升的原因尚不清楚。
通过比较胃手术（十二指肠-胃食管反流的人体模型）的频率以及食管腺癌患者和食管鳞状细胞癌患者之间的其他潜在风险因素，来检验十二指肠-胃食管反流导致食管腺癌的假说。
回顾了1987年至1994年间在克利夫兰诊所基金会就诊的所有食管腺癌或鳞状细胞癌患者的病历。收集了以下数据：年龄、性别、种族、肿瘤位置、胃手术史和胃食管反流症状，以及烟草、酒精、组胺-2受体拮抗剂和质子泵抑制剂的使用情况。
分析了325例腺癌患者（73.5%）和117例鳞状细胞癌患者（26.5%）的数据。两组在年龄、胃手术比例（腺癌患者：1.2%，95%置信区间0.3 - 3.1%；鳞状细胞癌患者：0.9%，95%置信区间0.0 - 4.7%）、吸烟（76.7%对81.6%）或饮酒（71.8%对79.1%）方面均未发现差异。与食管腺癌相关的显著风险因素为男性、白种人、肿瘤位于远端以及巴雷特食管。
食管癌患者中很少有既往胃手术史，且食管腺癌患者和鳞状细胞癌患者进行胃手术的频率相同。这表明胃手术及其相关的十二指肠-胃食管反流在食管腺癌的病因及发病率上升中不起作用。60岁左右、患有巴雷特食管、吸烟且饮酒的白人男性患食管腺癌的风险最高。
