食管癌发生发展过程中p53蛋白表达的研究

目的研究p53蛋白在食管癌及癌前病变组织中的表达,探讨其在食管癌发生、发展过程中的作用。方法应用免疫组织化学方法检测43例鳞状细胞癌及22例增生性病变(单纯性增生8例,轻、中、重度不典型增生分别为6例、4例、4例)和6例正常食管黏膜鳞状上皮的食管组织中p53蛋白的表达情况。结果在正常食管黏膜上皮,单纯性增生,轻、中度不典型增生中,未发现p53蛋白的表达;在75%(3/4)重度不典型增生、56%(24/43)食管鳞状细胞癌中p53蛋白表达阳性。p53蛋白表达在I～II期为18%(2/11),III～IV期为77%(10/13)。p53蛋白表达,与淋巴转移、浸润深度、肿物大小无关。结论 p53蛋白的表达与食管癌发生发展关系密切,是食管癌发生发展中的一个重要指标。可作为食管癌可疑病例定期随访的指标之一,以便发现早期食管癌,做到早诊断早治疗。     

食管癌早期诊断对手术方式的影响

目的探讨食管癌早期诊断对手术方式的影响。方法对3 000名年龄41⁶9岁的农村健康成年人人群进行早期食管癌筛查。行胃镜检查后,内镜退至食管时进行2%卢氏碘染色,并对浅染色和不染色的黏膜进行活检,送病理检查。结果在3000人被检查对象中,查出食管黏膜轻度不典型增生700例,中度不典型增生6例。筛查出需要治疗的阳性患者共9例,其中食管黏膜中度不典型增生1例,食管黏膜高级别上皮内瘤变3例,食管黏膜鳞状细胞癌5例,其中,有3例黏膜病变<2 cm,2例黏膜病变>2 cm。在9阳性患者中,4例患者已经在上级医院行内镜下手术治疗。结论筛查并诊断出早期食管癌患者,可以选择内镜下手术治疗,减轻患者痛苦及经济负担,提高生存时间。     

食管癌发生发展过程中COX-2蛋白表达的研究

目的研究环氧合酶-2(COX-2)蛋白在食管癌及癌前病变组织中的表达,探讨其在食管癌发生、发展过程中的作用。方法应用免疫组织化学方法检测43例鳞状细胞癌及22例增生性病变(单纯增生8例,轻、中、重度不典型增生分别6、4、4例)和6例正常食管黏膜鳞状上皮的食管组织中COX-2蛋白的表达情况。结果正常食管黏膜上皮、单纯性增生和轻/中度不典型增生未发现COX-2蛋白表达;25%(1/4)重度不典型增生、74%(32/43)食管鳞状细胞癌中COX-2蛋白表达阳性。COX-2蛋白表达I-II期强阳性率为40%(4/10),III-IV期为73%(10/22);COX-2蛋白的表达与淋巴转移、浸润深度、肿物大小无关。结论 COX-2蛋白的表达与食管癌的发生发展关系密切,是食管癌发生发展中的一个重要指标。     

不同浓度碘染色液对食管癌普查检出率的影响

目的研究不同浓度碘染色对食管早期癌和不典型增生的检出率,阐明碘染色的临床意义。方法分别应用1.2%卢沟氏碘对3217例,1.5%卢沟氏碘对2694例高发区人群进行碘液染色普查,在直径〉0.5 cm的不染区或淡染区内取活检,计算轻、中、重度不典型增生和早癌的检出率。结果 1.5%卢沟氏碘液组轻度、中度和重度不典型增生/早癌的检出率分别为2.37%、0.71%、0.45%,1.2%碘液组检出率分别为1.93%、0.68%、0.25%和0.31%。结论 1.5%卢沟氏碘染色比1.20%卢沟氏碘染色更能显著提高食管早癌和不典型增生的检出率,可作为筛检食管早癌和不典型增生的一种安全、简便而有效的手段。     

内镜下窄带光谱成像技术联合碘染色检查对进展期食管癌的诊断价值

目的 探讨内镜窄带光谱成像技术联合碘染色检查对进展期食管癌的诊断价值.方法 回顾性分析2010年11月至2012年5月于北京大学肿瘤医院接受上消化道内镜检查的162例进展期食管癌患者的临床资料,在内镜检查中依次使用白光内镜、窄带光谱成像技术(窄带光谱内镜)和Lugol碘液染色(染色内镜)观察模式进行观察,分别记录病灶长度.将窄带光谱内镜或染色内镜观察模式下的癌旁异常黏膜作为可疑边界取标本进行活组织病理检查,计算与白光内镜观察模式下测量病灶边界的差值.对接受手术治疗的患者记录手术入路和吻合方式,对未选择手术治疗的患者随访其最终的治疗方式.比较内镜检查前后治疗方案的差异.结果 162例患者中,3种观察模式下测量病灶边界一致者121例,不一致者41例.41例患者中测量差值为1 ～3 cm者22例,＞3 cm且≤5 cm者8例,＞5 cm且≤10 cm者7例,＞ 10 cm者4例;测量差值＞5 cm的患者均为多发斑片状不着色.以上4类患者中,分别有1、2、2、4例最终接受了新辅助放化疗,其余32例患者接受手术治疗.41例病灶边界不一致者取可疑的癌旁黏膜进行活组织病理检查,其中鳞状细胞癌31例、原位癌3例、重度不典型增生7例.153例接受手术治疗的患者中,12例修改了手术方案,其中2例由胸内吻合改为颈部吻合,3例由主动脉弓下吻合改为弓上吻合,7例由单纯经腹手术改为经胸腹两切口手术.结论 内镜检查中启用窄带光谱内镜或染色内镜观察模式测量进展期食管癌病灶的准确性更高,对于在3种观察模式下测量病灶边界不一致者应取癌旁异常黏膜进行病理检查,有助于制订更合理的治疗方案.     

Src家族酪氨酸激酶Fyn在人食管鳞状细胞癌中的表达

目的 探讨食管鳞状细胞癌组织中Fyn的表达水平及其意义.方法 收集13例食管鳞状细胞癌组织(ESCC)和10例食管正常黏膜上皮组织(UNR),采用免疫组织化学法和免疫印迹法分析食管鳞状细胞癌组织及食管正常黏膜组织Fyn蛋白表达水平的变化.结果 免疫组织化学染色显示食管鳞状细胞癌组织中Fyn蛋白表达水平(9.68±2.31)高于食管正常黏膜组织中染色指数(3.21±1.25),差异有统计学意义(P<0.01).免疫印迹结果亦显示食管鳞癌组织中Fyn蛋白表达强于食管正常黏膜组织.结论 Fyn蛋白在食管鳞状细胞癌组织中高表达,提示Fyn基因在食管鳞状细胞癌的发生发展过程中可能起重要作用.     

食管癌外科治疗进展

对于所有的癌肿,早期发现才会有较好的治疗效果,但大多数食管癌发现时已属进展期,小的食管病变,尤其是上皮内癌很难发现。随着内镜技术的发展和改进以及内镜直视下活检的广泛应用,早期食管癌诊断的病例愈来愈多。自1985年以来,作者做内镜检查发现食管粘膜异常时,采用 Lugol 液染色并取怀疑部位活检。平坦的病变常无颜色改变或可能表现为一个红点,内镜下可清楚地观察到这些病变 Lugol 染色不着染。通过该技术共发现6例上皮癌、3例粘膜癌、75例粘膜下癌,表明内镜下 Lugol 染色并活检是现今发现小的食管癌的、最有效的诊断方法。在大多数情况下,这类病变常常是     

内镜下碘染色并活检对早期食管癌的临床诊断价值

目的分析内镜下碘染色并活检对早期食管癌的临床诊断价值。方法对2013-01—2015-10收治的322例经内镜检查有食管黏膜可能病变的患者行碘染色及活检,详细记录食管病灶的形态、位置及大小。对活检结果与食管着色区域组织的病理检查结果做对比分析。结果本组322例患者进行碘染色前怀疑病变点398处,行碘染色后289例出现无染区以及淡染区共319处,约1/3病例出现2处及以上无染区及淡染区。敏感性89.8%。发现早期食管癌68例,均经病理证实,染色前后食管癌检出率差异有统计学意义(P0.05)。诊断中、重度异型增生137例,其中染色前后发现食管黏膜存在中、重度异型增生的患者分别为16例(5.0%)和121例(37.6),两者差异有统计学意义(P0.05)。结论应用内镜下碘染色并活检检查对早期食管癌以及癌前病变可获得较为理想的检诊率,值得在基层临床推广应用。     

乳腺不典型增生和乳腺癌中p53、ER表达的意义

目的探讨p53基因产物和雌激素受体(ER)在乳腺不典型增生和乳腺癌中表达及意义。方法用ABC免疫组化法检测乳腺不典型增生和乳腺癌细胞p53基因产物和ER表达。结果乳腺上皮不典型增生Ⅰ级者上皮细胞ER染色结果与正常乳腺上皮细胞相似，不典型增生Ⅱ级ER表达明显增强，22／24例阳性，不典型增生Ⅲ级20／22例见ER染色阳性。在乳腺上皮不典型增生Ⅰ级无p53蛋白表达，不典型增生Ⅱ级、Ⅲ级中分别有3／24和7／22例p53蛋白表达。乳腺癌59例，ER阳性率为36／59(61．02％)。乳腺癌p53蛋白表达阳性22／59(37．29％)。结论p53可促进正常细胞以不典型增生向癌的转化，ER对不典型增生癌变起重要的刺激、激活作用。p53-／ER 代表正常组织、良性增生与高分化和好的预后，p53 ／ER-多为不典型增生、低分化癌和差的预后。所以同时检测p53、ER对判断不典型增生向癌的转化及乳腺癌患者的预后有重要意义。     

���Ұ���ػ���������־����о���չ

原发性胆囊癌是胆道系统最常见的恶性肿瘤 ,恶性程度高、预后差 ,在基因水平上研究胆囊癌的生物学行为 ,有助于胆囊癌的早期诊断和治疗。1　与胆囊癌发生有关的基因1.1　p5 3　p5 3基因是胆囊癌中研究最多的基因 ,其检测阳性率在 34 .7%～ 6 5 .4%之间 ,最高可达到 92 %。在胆囊原位癌和不典型增生组织中 p5 3蛋白有较高的阳性表达率 ,癌旁粘膜是否存在p5 3蛋白的过度表达仍未形成一致意见 ,比较明确的是胆囊腺瘤和化生的上皮组织没有阳性表达 ,提示 p5 3基因的过度表达在胆囊癌的形成中是一个早期事件 ,p5 3基因突变可能与胆囊癌的发生有密…     

Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer

BACKGROUND: Head and neck cancer (HNC) has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous HNC and esophageal cancer. The early detection of superficial esophageal cancer and dysplasia in asymptomatic patients with HNC, after successfully treating the primary cancer, may provide an effective cure. METHODS: A prospective study involving 60 patients with HNC was carried out at the State University of Campinas (UNICAMP) to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2% lugol dye solution followed by biopsy of the suspicious areas. RESULTS: Five patients (8.3%) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0%). In four patients, the superficial esophageal cancer was synchronous, and in one it was metachronous to HNC. Five patients (8.3%) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). CONCLUSION: These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with HNC, particularly because superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients.     

Endoscopic evaluation of the depth of invasion in cases of superficial esophageal cancer in determining indications for endoscopic mucosal resection

Endoscopic mucosal resection (EMR) should be performed for the treatment of squamous cell carcinoma of the esophagus limited to the lamina propria mucosae (m1 and m2 cancers), because lymph node metastasis is rare in these cases. The lymph node metastasis rate is 6% when cancers reach the muscularis mucosa(m3) or slightly invade the submucosa (sm1). Lymph node metastasis is noted in 47% of esophageal cancers moderately or severely invading the submucosa(sm2 and sm3). Radical esophagectomy is recommended for sm2 and sm3 disease. Type 0-II cancers are candidates for EMR, because 86% remain within the mucosa, while 90% of type 0-I lesions and 96% of type 0-III lesions are submucosal cancers. Among type 0-II cancers, most type 0-IIb lesions are m1 cancer. Among type 0-IIa cancers, 96% are mucosal. Type 0-IIc lesions are frequent among superficial esophageal cancers and 19% reach the submucosa. Endoscopic diffrentiation of m1 and m2 cancers is reliable, since 96% of all m1 and m2 cancers were correctly diagnosed before treatment. In cases with type O-IIc lesions which is most frequent among superficial esophageal cancers, m1 cancer showed very slight depressions with a smooth surface and reddening. Sometimes fine granular changes are seen. They are also delineated as an unstained area by endoscopic toluidine blue-iodine double staining. They showed very slight depressions with a smooth surface and reddening. Sometimes fine granular changes are seen. They are also delineated as an unstained area by endoscopic toluidine blue-iodine double staining. Dark blue dots, spots, or reticular staining are frequently identified in m2 cancers. In cases with m3 or sm1 cancer, coarse granular changes, small nodular elevations, or slightly deeper depressed areas in the m1 and m2 lesions suggest sites of deeper invasion.     

Preclinical study of adenoviral p53 gene therapy for esophageal cancer

An alteration of the p53 gene function is a major factor in the development of esophageal cancer. Recently, p53 gene therapy has been applied for clinical studies in lung cancer and head and neck cancer. However, no preclinical studies have yet demonstrated an anticancer effect of adenoviral-mediated wild-type p53 gene therapy on esophageal cancer. We herein evaluated the effect of p53 adenoviral gene therapy on human esophageal squamous cell carcinoma to test the ability of clinical application. A normal esophageal epithelial cell line (EN53F) and two human esophageal cancer cell lines (ECGI-10 and T.Tn) with a p53 alteration were used. The transduction efficiency, p53 protein expression, p21 protein expression, the induction of apoptosis, and growth suppression were assessed by using the recombinant adenoviral vector Ad5CMV-p53. The transduction efficiency was 60%–80% at 100 plaque-forming units (PFU)/cell and 80%–100% at 300 PFU/cell. A significant growth suppression following an Ad5CMV-p53 infection was observed in both cancer cell lines. A Western blot analysis confirmed the presence of both exogenous p53 protein expression and p21 protein induction. Apoptotic cell death was observed with TUNEL staining. T.Tn xenografts in nude mice transduced with Ad5CMV-p53 demonstrated significant growth suppression. These data suggest that Ad5CMV-p53 may thus be a potentially effective therapeutic agent for locally advanced esophageal cancer. Received: July 19, 2000 / Accepted: January 9, 2001     

Cytophotometric DNA analysis of the early and superficial esophageal cancer

Although it is widely known that early esophageal cancer (n-) patients have a favorable prognosis after surgery and the superficial esophageal cancer (n+) patients have a poor one, the differences between them have not been found out under the microscopic examination of the primary lesion. Cytophotometric DNA analysis of the primary lesion was done to search for the differences between early and superficial esophageal cancer. Significant differences were obtained in the mean DNA value (p less than 0.01), the percentage of nuclei beyond tetraploid (p less than 0.001) and the product of 2 indices above (p less than 0.001). The result suggests that cytophotometric DNA analysis is a useful means for differentiating the early esophageal cancer from the superficial esophageal cancer and that the most suitable perioperative combined therapy can be chosen through the Feulgen-stained biopsy specimen.     

The expression of oncoproteins in transitional cell carcinoma: its correlation with pathological behavior,cell cycle and drug resistance

OBJECTIVE: To investigate the relationship of oncoproteins with histological grade, tumor stage, cell cycle and multidrug resistance (MDR) in bladder cancer. METHODS: The expression of various oncoproteins (p21, EGFR1, erbB-2, c-jun, c-myc, bcl-2, Bax) and suppressor gene products (WT-1, RB gene, p53) was studied in normal urothelium, transitional cell carcinoma (TCC) cell lines and their MDR sublines by using specific antibodies and an indirect immunofluorescence flow-cytometric method. RESULTS: The total increased rate of measured oncoproteins in TCC cell lines was 62.7%. There was no difference in the expression rate of oncoproteins between low-grade/stage TCC cell lines and high-grade/stage TCC cell lines. All of these TCC cell lines have aneuploidy and increased proliferative activity in the cell cycle, but a correlation with oncoprotein expression was not seen. They had a low expression rate of c-myc, Bax and RB gene when compared to normal urothelium. On the contrary, the expressions of p21, EGFR1, erbB-2, bcl-2, WT-1 and p53 oncoproteins were significantly higher than in normal urothelium (p < 0.05). A long-term cultured MDR subline of TCC8702 (TCC8702/ADR1000) demonstrated a generally decreasing expression of oncoproteins in addition to p53. CONCLUSIONS: The p21, EGFR1, erbB-2, bcl-2, WT-1 and p53 oncoproteins were increased in TCC cells compared to normal urothelium. Oncoprotein expression is related to tumorigenesis of TCC cells, but no correlation was seen between the incidence and tumor differentiation and cell cycle. These oncoproteins decreased gradually in the process of generation of MDR in addition to p53. It indicates that the p53 oncogene is closely related to the acquired MDR of TCC cells.     

Immunohistochemical analysis of p53 and ras p21 expression in colorectal adenomas and early carcinomas

To further investigate whether multiple genetic changes are involved in the development of colorectal cancer, we performed an immunohistochemical analysis of p53 and ras p21 protein expression in 139 specimens of colorectal adenoma with varying degrees of dysplasia, 57 specimens of early cancer with an adenomatous component, and 12 specimens of superficial early cancer without any adenomatous component. Positive p53 staining was found in 15% of the adenomas with moderate dysplasia and in 42% of the adenomas with severe dysplasia or intramucosal carcinoma (IMCA). Positive immunostaining of p53 was observed to be significantly correlated with the degree of dysplasia and the depth of invasion, as was the expression of ras p21. However, a closer correlation was observed with the increasing size of the adenomas. Furthermore, p53 staining was positive in 42% of the 12 superficial early cancer specimens, while ras staining was positive in only 1 specimen (8%). These results indicate that p53 gene overexpression may play some biological role in both the adenoma-to-carcinoma sequence and in de novo cancer development, whereas ras p21 expression may not be as involved in de novo cancer development as in the malignant conversion of colorectal adenomas.     

Reciprocal expression of bcl-2 and p53 oncoproteins in urothelial dysplasia and carcinoma of the urinary bladder

In order to investigate if and when the bcl-2 oncoprotein is activated in bladder tumorigenesis and its relationship with p53 overexpression and patient survival, we studied bcl-2 and p53 expression immunohistochemically in matched normal urothelium, dysplasia and cancer specimens selected by step-sectioning from 54 radically resected bladders for non-metastatic transitional cell carcinoma (TCC). In normal urothelium and mild dysplasia, bcl-2 was restricted to the basal cell compartment, while in moderate and severe dysplasia its expression was detectable also in the upper regions. Excess bcl-2 immunoreactivity was found in 27 (50%) of carcinomas, and a larger proportion of high-grade TCCs showed bcl-2 expression compared with that of low-grade TCCs (P < 0.05). Overexpression of p53 protein showed a increasing trend toward the progression of bladder tumorigenesis (P < 0.01) and a significant reciprocal correlation was found between bcl-2 and p53 expression in either various dysplasias (P < 0.01) or carcinoma (P < 0.05). With the evolution from mild dysplasia to carcinoma in individual cases, loss of bcl-2 expression was more frequently observed in superficial (P < 0.02) or low-grade carcinoma (P < 0.05) than in muscle-invasive or high-grade carcinoma. Furthermore, patients with negative immunostaining for both bcl-2 and p53 in cancer lesions had a significantly more favorable prognosis compared with those with positive immunostaining for the oncoproteins (P < 0.05), although bcl-2 by itself did not predict patient survival. We suggest that aberrant activated bcl-2, which is seen earlier than p53, appears to facilitate bladder tumorigenesis and to enhance tumor aggression in some extent. Received: 22 October 1997 / Accepted: 2 January 1998     

Combined analysis of p53 and retinoblastoma protein expressions in esophageal cancer

BACKGROUND: p53 gene mutation and abnormal p53 protein expression, also loss of the retinoblastoma gene and protein expression are frequently associated with esophageal squamous cell carcinoma (ESCC). Recently, the prognostic significance of the combined analysis of p53 protein and retinoblastoma protein (pRB) has been reported in non-small cell lung cancer. However, in ESCC, the prognostic significance of the combined analysis of these proteins remains unclear. In this study, we immunohistochemically analyzed the p53 protein and pRB expressions in surgically resected ESCC, and we evaluated the prognostic significance of the combination of these proteins. METHODS: We analyzed p53 protein and pRB expressions immunohistochemically in 191 surgically resected ESCC cases. Overexpression of p53 and loss of pRB were considered abnormal. RESULTS: Overexpression of p53 protein was detected in 79 patients (41%) and decreased pRB nuclear staining occurred in 82 (43%). The Kaplan-Meier survival curve showed that absence of pRB expression was significantly associated with shortened survival (p = 0.001), whereas expression of p53 was not significantly associated with survival. Moreover, p53 and pRB status individually were not independent prognostic factors in multivariate survival analysis. With respect to pRB and p53, the tumors could be grouped into four categories: p53-/pRB+ (31%); p53-/pRB- (27%); p53+/pRB+ (26%); and p53+/pRB- (16%). Favorable prognosis was observed in patients with p53-/pRB+ tumors. Multivariate analysis showed p53-/pRB+ status to be an independent prognostic factor. CONCLUSIONS: The combination of p53 protein loss and pRB expression was associated with good prognosis in patients with ESCC.     

Immunohistochemistry analysis of micrometastasis in pretreatment lymph nodes from patients with esophageal cancer

BACKGROUND: With recent advances in neoadjuvant therapy in esophageal cancer, pretreatment lymph node staging has become increasingly important in stratifying patients to appropriate treatment regimens and for prognostication. Immunohistochemical analysis (IHC) using epithelial markers has been shown to identify micrometastases in histologically negative lymph nodes. We performed this study to evaluate if IHC analysis in thoracoscopic/laparoscopic (Ts/Ls) pretreatment staging lymph nodes can reveal additional diagnostic information to routine histopathology. METHODS: Specimens of 106 patients with esophageal cancer who had pretreatment Ts/Ls staging were retrospectively studied. Lymph node biopsies were obtained for IHC staining using cytokeratin (CK) of AE1/AE3. IHC staining for p53, an apoptosis protein associated with poor prognosis in esophageal cancer, was also performed. RESULTS: 331 Ts/Ls staging lymph node biopsies were collected from 106 patients. A total of 15.4% (51/331) of the lymph nodes or 34.9% (37/106) of patients were found to have metastatic deposits by routine histology. All the histologically positive lymph nodes were CK positive. Among the remaining 280 histologically negative lymph nodes, 11(3.9%) were found to have micrometastasis by CK staining. Three patients (4.3%, 3/69) were upstaged from N0 to N1. They died of early recurrences after treatment. A total of 67.6% (25/37) of the patients with histologically positive lymph node were p53 positive. No histologically negative lymph node was found to be p53 positive in this series. CONCLUSIONS: Immunohistochemical analysis for CK can detect micrometastatic involvement of lymph nodes that are missed on routine pathologic examination, and, therefore, can improve lymph node staging. Its clinical significance in esophageal cancer warrants further study.     

窄带成像与碘染色在早期食管癌内镜黏膜下剥离术中的应用比较

目的比较窄带成像（NBI）与碘染色在早期食管癌内镜黏膜下剥离术（ESD）治疗中的临床价值。方法回顾性分析2010年9月至2011年8月间接受ESD治疗的87例早期食管癌（包括高级别上皮内瘤变）患者的临床资料,其中术前经NBI法确定病变边界者37例（NBI组）,采用碘染色法确定病变边界者50例（碘染色组）。比较两组患者ESD术中食管痉挛程度、手术时间、完整切除率、并发症发生率以及术后复发等情况。结果两组患者病变部位、大小和周径的差异均无统计学意义。NBI组中重度食管痉挛者的比例为10．8％（4／37）,明显低于碘染色组的比例[32．0％（16／50）,P〈0．05];手术时间亦明显短于碘染色组[（42．2±19．5）min比（53．3±30．9）rain,P〈0．05]。NBI组术中穿孔1例,术后迟发性出血1例;碘染色组术中穿孔1例,均经内镜下处理及保守治疗治愈。术后随访4～20月,NBI组与碘染色组患者术后食管狭窄[8．1％（3／37）比8．0％（4／50）]和局部复发[5．4％（2／37）比4．0％（2／50）]发生率的差异均无统计学意义（均P〉0．05）。结论与碘染色相比,早期食管癌ESD术前采用NBI确定病变边界,可在不影响疗效的基础上减轻食管痉挛并缩短手术时间。