Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma
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DOI：
10.1056/nejm199903183401101
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发表时间：
1999-03-18
影响因子：
158.5
通讯作者：
Nyrén, O
中科院分区：
文献类型：
--
作者：
Lagergren, J;Bergström, R;Nyrén, O
背景 人们对食管和贲门腺癌的病因知之甚少。我们对胃食管反流与这些肿瘤之间可能存在的关联进行了流行病学调查。方法我们在瑞典进行了一项全国性的、以人群为基础的病例对照研究。案件查明速度快，所有案件均统一分类。有关受试者胃食管反流病史的信息是通过个人访谈收集的。通过逻辑回归计算优势比，并对潜在的混杂变量进行多变量调整。 结果 在接受采访的患者中，189 名食管腺癌患者和 262 名贲门腺癌患者占瑞典 1995 年至 1997 年期间符合研究资格的 529 名患者的 85%。为了进行比较，我们采访了来自瑞典的 820 名对照受试者。 普通人群和 167 名食管鳞状细胞癌患者。在有反流症状反复出现的人中，与没有此类症状的人相比，食管腺癌的比值比为 7.7（95% 置信区间，5.3 至 11.4），贲门腺癌的比值比为 2.0（95% 置信区间，1.4 至 2.9）。反流症状越频繁、越严重和持续时间越长，风险就越大。在长期存在严重反流症状的人中，食管腺癌的比值比为 43.5（95% 置信区间，18.3 至 103.5），贲门腺癌的比值比为 4.4（95% 置信区间，1.7 至 11.0）。食管鳞状细胞癌的风险与反流无关（比值比，1.1；95% 置信区间，0.7 至 1.9）。 结论 胃食管反流与食管腺癌之间存在很强的因果关系。反流与贲门腺癌的关系相对较弱。 （N Engl J Med 1999；340：825-31。）(C) 1999，马萨诸塞州医学会。
Background The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors.Methods We performed a nationwide, population-based, case-control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables.Results Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent symptoms of reflux, as compared with persons without such symptoms, the odds ratios were 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophageal adenocarcinoma and 2.0 (95 percent confidence interval, 1.4 to 2.9) for adenocarcinoma of the cardia. The more frequent, more severe, and longer-lasting the symptoms of reflux, the greater the risk. Among persons with long-standing and severe symptoms of reflux, the odds ratios were 43.5 (95 percent confidence interval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4 (95 percent confidence interval, 1.7 to 11.0) for adenocarcinoma of the cardia. The risk of esophageal squamous-cell carcinoma was not associated with reflux (odds ratio, 1.1; 95 percent confidence interval, 0.7 to 1.9).Conclusions There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma. The relation between reflux and adenocarcinoma of the gastric cardia is relatively weak. (N Engl J Med 1999; 340:825-31.) (C) 1999, Massachusetts Medical Society.