Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population
Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population
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DOI：
10.1136/gut.2004.046631
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发表时间：
2005-02-01
期刊：
影响因子：
24.5
通讯作者：
Dawsey, SM
中科院分区：
文献类型：
--
作者：
Wang, GQ;Abnet, CC;Dawsey, SM
背景：食管鳞状细胞癌（OSCC）的预后很差，这主要是由于诊断较晚。成功的早期检测策略将需要识别的临床相关的前驱病变，可以筛选和treatment.Aims的目标：以确定临床相关的组织学前兆OSCC.Subjects：一个队列的682内镜患者从一个高风险的农村人口在林县，中国。我们估计的相对风险发展为每个最初的组织学诊断使用考克斯比例风险回归models.Results：共有114（16.7%）患者发展为口腔鳞状细胞癌在随访期间。调整潜在混杂因素后，根据初步组织学诊断，该肿瘤的发生率（95%置信区间）为：正常1.0（参考），食管炎0.8基底细胞增生1.9（0.8 - 4.5），轻度异型增生2.9（1.6 - 5.2），中度异型增生9.8（5.3 - 18.3），重度异型增生28.3原位癌34.4（16.6 - 71.4）.结论：在本研究中，鳞状不典型增生和原位癌是与口腔鳞状细胞癌发生风险显著增加相关的唯一组织学病变，内窥镜检查后13.5年。没有证据表明食管炎易患这种肿瘤。异型增生分级的增加与风险增加密切相关，表明组织学分级具有临床意义。重度异型增生和原位癌的随访经验是等同的，表明这种区别没有临床意义。记录OSCC的这些前期病变应有助于制定针对这种疾病的有效预防、早期检测和治疗策略。
Background: Oesophageal squamous cell carcinoma (OSCC) has a very poor prognosis, which is largely due to late diagnosis. Successful early detection strategies will require identification of clinically relevant precursor lesions that can be targets for screening and treatment.Aims: To identify the clinically relevant histological precursors of OSCC.Subjects: A cohort of 682 endoscoped patients from a high risk rural population in Linxian, China.Methods: Subjects were endoscoped and biopsied at baseline and followed for 13.5 years. We estimated the relative risk of developing OSCC for each of the initial histological diagnoses using Cox proportional hazards regression models.Results: A total of 114 (16.7%) patients developed OSCC during the follow up period. After adjusting for potential confounding factors, relative risks (95% confidence intervals) for incidence of this tumour, by initial histological diagnosis, were: normal 1.0 ( reference), oesophagitis 0.8 (0.2 - 3.2), basal cell hyperplasia 1.9 ( 0.8 - 4.5), mild dysplasia 2.9 (1.6 - 5.2), moderate dysplasia 9.8 (5.3 - 18.3), severe dysplasia 28.3 (15.3 - 52.3), and carcinoma in situ 34.4 (16.6 - 71.4).Conclusions: In this study, squamous dysplasia and carcinoma in situ were the only histological lesions associated with a significantly increased risk of developing OSCC within 13.5 years after endoscopy. There was no evidence that oesophagitis predisposed to this tumour. Increasing grades of dysplasia were strongly associated with increasing risk, indicating that the histological grading was clinically meaningful. The follow up experience of severe dysplasia and carcinoma in situ was equivalent, suggesting that this distinction is not clinically relevant. Documenting these precursor lesions of OSCC should assist in the development of effective prevention, early detection, and treatment strategies for this disease.