食管癌高发区无症状居民食管癌前病变36 a(1986-2021)随访转归  

Outcome of esophageal precancerous lesions in asymptomatic residents from esophageal cancer high incidence areas with 36 years(1986-2021)follow-up

作　　者：赵学科[1] 徐瑞华 雷玲玲 李志强 丰善良 魏梦霞 范宗民[1] 宋昕[1] 韩雪娜[1] 陈红梅 王伟[1] 孟超龙 郝晓兰 裘宋良 王立东[1] ZHAO Xueke;XU Ruihua;LEI Lingling;LI Zhiqiang;FENG Shanliang;WEI Mengxia;FAN Zongmin;SONG Xin;HAN Xuena;CHEN Hongmei;WANG Wei;MENG Chaolong;HAO Xiaolan;QIU Songliang;WANG Lidong(State Key Laboratory of Esophageal Cancer Prevention and Treatment,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Gastroscopic Room,the Third People′s Hospital,Huixian City,Henan 453621;Zhengtun Village Clinic,Mengzhuang Town,Huixian City,Henan 453621)

机构地区：[1]郑州大学第一附属医院省部共建食管癌防治国家重点实验室,郑州450052 [2]辉县市第三人民医院胃镜室,河南辉县453621 [3]辉县市孟庄镇郑屯村卫生室,河南辉县453621

出　　处：《郑州大学学报（医学版）》2022年第1期6-9,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家杰出青年科学基金项目(30025016);国家自然科学基金面上项目(81872032);河南省科技重大专项(161100311300)。

摘　　要：目的:分析食管癌前病变的转归及其对食管癌变的远期影响。方法:1986年5-6月份对河南省辉县市孟庄镇814名30岁及以上的无症状居民进行食管内镜检查和黏膜活检。受检对象均进入长期随访队列,每年定期进行一次随访,测量血压、身高、体重等,问卷调查家族史、各种良恶性疾病史,记录肿瘤诊疗信息。结果:截至2021年6月30日,共随访36 a,有效随访796人,累计112人患14种不同类型恶性肿瘤,其中食管癌75例(占67.0%),消化道肿瘤95例(占84.9%)。1986年活检病理诊断为正常食管黏膜上皮(NOR)442人(占55.5%),其中30人(6.8%)36 a内发生食管癌;食管上皮基底细胞过度增生(BCH)281人(占35.3%),其中21人(7.5%)发生食管癌;食管上皮不典型增生(DYS)73人(占9.2%),其中24人(32.9%)发生食管癌。DYS无症状居民较NOR者发生食管癌的风险增高6倍。NOR、DCH和DYS发展为食管癌间隔时间的中位数(P25,P75)分别为22.00(3.50,27.00)、11.00(6.00,24.25)和5.50(3.00,12.00)a,差异有统计学意义(H=8.409,P=0.015)。结论:DYS是重要的食管癌前病变;食管癌仍是该地区患病率最高的恶性肿瘤。Aim:To clarify the outcome of esophageal precancerous lesions and its long-term effect on esophageal carcinogenesis.Methods:Endoscopy and mucosal biopsy were performed on 814 asymptomatic residents over 30 years old in Mengzhuang Town,Huixian City,Henan Province in 1986.All subjects were enrolled in the cohort for long-term follow-up once a year.Blood pressure,height and weight were measured,and family history,history of suffering from diseases,etc were obtained via questionaire.Results:By June 30,2021,during the follow-up,a total of 796 asymptomatic residents were enrolled and 112 patients developed 14 kinds of different type of malignant tumors.In 1986,442(55.5%)were pathologically diagnosed as normal esophageal mucosal epithelium(NOR),281(35.3%)were basal cell hyperplasia,73(9.2%)were dysplasia,and accordingly,30(6.8%),21(7.5%)and 24(32.9%)developed esophageal cancer during 36 years of follow-up.The risk of esophageal cancer occured in dysplasia cases was 6 times as high as that in NOR cases.The median interval((P25,P75))of from NOR,BCH and DYS to carcinoma was 22.00(3.50,27.00),11.00(6.00,24.25)and 5.50(3.00,12.00)years,respectively,the difference in them were significant(H=8.409,P=0.015).Conclusion:Dysplasia is the very important precancerous lesion of esophageal cancer.Esophageal cancer remains the most common malignant tumor in this area.

关 键 词：食管癌前病变 无症状居民 食管癌高发区 随访转归 

分 类 号：R735.1[医药卫生—肿瘤]