Rising incidence of oesophageal adenocarcinoma in men in Australia

Adenocarcinomas of the oesophagus and of the gastric cardia have been reported to be increasing in incidence in many countries, while the incidence of squamous cell carcinoma of the oesophagus is stable and non-cardia gastric cancers are decreasing in incidence. Age-standardized incidence rates for the years 1982–93 for oesophageal adenocarcinoma and non-adenocarcinoma, and gastric cardia and non-cardia cancers were calculated based on state cancer registry incidence data. Time trends in the age-standardized rates were assessed using linear regression. A consistent increasing trend in the incidence of oesophageal adenocarcinoma in men was seen in all states of Australia and was statistically significant in all states except South Australia. There were no consistent nationwide trends in the incidence of oesophageal adenocarcinoma in women, although a trend towards an increase in the incidence of this cancer reached statistical significance ( P < 0.05) in three states (New South Wales, Victoria, Queensland). There were no important trends in the incidence of oesophageal non-adenocarcinoma in either men or women. There were no consistent nationwide changes in the incidence of gastric cardia cancer in either men or women, although this cancer was significantly increasing in Tasmania in both men and women. The incidence of cancer of the stomach not arising at the gastric cardia was significantly decreasing in men in all states and was also decreasing in women in all states, although in women this decrease was statistically significant only in New South Wales, Victoria and Western Australia. There has been a dramatic increase in the incidence of oesophageal adenocarcinoma in men in Australia. The incidence of this cancer in men is now approximately equal with that of non-adenocarcinoma of the oesophagus. The incidence of non-cardia stomach cancer continues to fall.     

P-糖蛋白在贲门癌原发灶及其淋巴结转移灶的表达及意义

目的探讨P-糖蛋白(P-gp)在贲门癌原发灶及其淋巴结转移灶的表达差异,并分析与临床病理学因素的关系。方法收集30例经病理确诊的贲门癌原发灶、淋巴结转移灶及对应癌旁正常组织,采用免疫组织化学二步法检测3组标本的P-gp表达。结果 (1)P-gp在淋巴结转移灶、原发灶及癌旁正常组织的阳性表达率分别为66.7%、40%和16.7%,P-gp在淋巴结转移灶中的表达高于原发灶,原发灶高于正常组织(P<0.05)。(2)P-gp在贲门癌原发灶的表达与性别、年龄、浸润深度及分化程度均无关(P<0.05);在淋巴结转移灶的表达与性别、年龄、浸润深度无关,与分化程度有关(P<0.05)。结论 P-gp参与贲门癌肿瘤细胞的原发性多药耐药;淋巴结转移灶与原发灶的肿瘤细胞间存在多药耐药异质性。     

Palliation of Oesophagogastric Neoplasms with Nd:YAG Laser Treatment

The palliative effect of endoscopic Nd:YAG laser treatment of malignant strictures of the oesophagus and cardia was prospectively evaluated in 30 patients. Most (n = 28) were primarily treated for dysphagia, and swallowing was improved in 21 and normalized in 14 of these patients. Two patients were successfully treated for bleeding. Six patients developed complications (including two perforations), and four of these were fatal. The median survival was 4 months (range, 17 days to 14 months). It is concluded that in a great number of patients with inoperable cancer of the oesophagus and cardia, laser treatment is better than other palliative procedures.     

同一个体食管贲门双源癌中人乳头瘤病毒感染和p16INK4A蛋白表达

目的 探讨河南食管癌高发区HPV感染与食管/贲门癌变的关系和p16INK4A蛋白表达的意义。方法 利用聚合酶链式反应技术（PCR）检测17例双源癌患者食管鳞癌组织和贲门腺癌组织人乳头瘤病毒16型（HPV16）感染情况,应用免疫组织化学方法检测p16INK4A蛋白在17例双源癌鳞癌组织和腺癌组织中的表达。结果 17例双源癌组织中8例食管鳞癌组织,5例贲门腺癌组织中检测到HPV16-DNA（47% vs. 29%）,且有2例患者食管鳞癌和贲门腺癌组织中同时检测到HPV16-DNA的存在。p16INK4A蛋白在两种组织中均有较高表达。在HPV相关的双源癌中,p16INK4A蛋白表达在腺癌组织中较鳞癌组织高（75% vs.25%,P＜0.05）。结论 河南食管癌高发区同一个体食管鳞癌和贲门腺癌中均有不同程度HPV感染,提示HPV可能是二者共同相关致病危险因素,高危型HPV16感染可能在河南食管癌高发区食管和贲门癌变过程中起重要作用。p16INK4A蛋白表达在腺癌组织中较鳞癌组织高,有可能成为HPV相关性贲门癌的一个筛查指标。     

医用图象处理系统的食管、贲门癌治疗决策的指导价值

食管、贲门癌软组织块影是食管、贲门癌患者上消化道钡餐检查重要的Ｘ线征象之一。但实际工作中，钡餐Ｘ线摄片很难提供确切的诊断依据。针对临床上大都是晚期病例，手术切除率颇低的现状。作者有目的地对４５例食管、贲门癌的钡餐检查资料，结合手术探查所见，通过ＮＡＩ２００医用计算机系统对钡餐Ｘ线图片进行处理后，发现该医用图象系统能明显地优化图片质量、能清楚地显示肿瘤外浸所形成的软组织块影，对肿瘤的范围、大小以及与外周的关系提供较为明确的印象，故对进一步提高诊断水平，为手术治疗决策提供依据。