SUCCESSFUL SCREENING FOR EARLY ESOPHAGEAL CANCER IN ALCOHOLICS USING ENDOSCOPY AND MUCOSA IODINE STAINING
SUCCESSFUL SCREENING FOR EARLY ESOPHAGEAL CANCER IN ALCOHOLICS USING ENDOSCOPY AND MUCOSA IODINE STAINING
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DOI：
10.1002/1097-0142(19950915)76:6
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发表时间：
1995-09-15
期刊：
影响因子：
6.2
通讯作者：
ISHII, H
中科院分区：
文献类型：
--
作者：
YOKOYAMA, A;OHMORI, T;ISHII, H
背景资料。流行病学研究表明，酗酒是食道癌的重要危险因素。然而，在大量饮酒的高危人群中，食道癌的早期发现尚无系统的筛查方案。在日本神奈川国立酒精中毒研究所，对629名男性酗酒者(54+/-8岁)进行了连续、系统的内窥镜结合碘染色和靶向活检的筛查。对于粘膜癌，采用内窥镜下食道黏膜切除术(EEMR)以达到确证诊断和治疗的目的。162例(25.8%)食管壁可见边界清楚、白色、最大径大于或等于5 mm的碘不染病变。在629名患者中，有21名患者的36个这样的未染色病变，出人意料地高达3.3%，结果是浅表型鳞癌。根据已建立的标准，其中17例患者接受了EEMR，其中3例接受了额外的放射治疗。2例行食道切除术，1例行化疗加放疗，另1例行内窥镜检查。8例患者癌侵袭局限于上皮内，9例局限于正常粘膜层，4例局限于粘膜下层。多因素Logistic回归分析显示，饮用烈性酒精饮料威士忌或烧酒(OR分别为1.47和2.94)与饮用清酒或啤酒和每天30支以上香烟(OR分别为1.68和3.85)相比，明显增加了不同的碘未染病变和浅表性食道癌的风险。对这些高危个体常规应用该程序可获得异常高的食道癌发现率。
Background. 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.Methods. 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.Results. 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).Conclusion. Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.