早期食管癌自然生存状态的长期观察

目的 观察拒绝治疗的早期食管癌患者的自然发展状态.方法 1985年至1990年间,在河南省林州市食管癌高发现场,完成内镜筛查4800例.按内镜下观察为浅表黏膜病变,经活检病理诊断为原位癌、黏膜内癌或鳞癌的标准,共检出132例早期食管癌患者,其中48例因不同原因拒绝治疗.对48例未经治疗的食管癌患者进行随访,观察其自然发展状态.随访期间,有40例患者曾做过1～4次内镜复查.结果 随访至2005年12月31日,48例患者中,5例仍生存,43例死亡,其中死于食管癌者38例,占79.2%;死于非癌疾病者5例,占10.4%.全组生存时间≥5年者37例,患者的5、10、15和20年生存率分别为77.1%、39.6%、25.0%和10.4%.结论 食管癌从早期发展到晚期是一个漫长的演变过程,这对于食管癌的早期诊断和选择治疗时机很有帮助.如果要评价早期食管癌的治疗效果,应充分考虑其自然发展史的领先时间偏倚.

Natural progression of early esophageal squamous cell carcinoma

Objective The survival time of untreated advanced esophageal squamous cell carcinoma is about 8-9 months. The objective of this study was to observe the natural progression of untreated early esophageal squamous cell carcinoma for 20 years. Methods 4800 subjects from a high risk area of esophageal cancer in Lin-zhou city, Henan province, were examined by endoscopy from 1985 to 1990.Among them, 132 cases were diagnosed as early esophageal cancer. Based on the criteria, the lesions were endoscopically diagnosed as superficial mucosal lesions and histopathologically confirmed by biopsy as carcinoma in situ, intramucosal carcinoma or squamous cell carcinoma. 48 of the 132 patients,who refused treatment, were followed up to the end of 2005. There were 43 death and 5 alive. 40 patients were re-examined for 1-4 times by endoscopy during the following up. Reseults A total of 48 patients have been followed up for 20 years.38 (79.2%) cases died of esophageal squamous cell carcinoma, 5 (10.4%) died of non-cancer diseases and 5( 10. 4% ) were surviving. 37 patients had survived for over 5 years. The 5-, 10-, 15- and 20-years survival rates were 77. 1%, 39. 6%, 25. 0% and 10. 4%, respectively. Conclusion The natural history of esophageal squamous cell carcinoma takes a long time to progress from early to advanced stage. It is very helpful for early diagnosis and selection of opportunity for treatment. The leading time bias by natural history of this disease should be considered when evaluate therapeutic effect on early stage esophageal cancer.