17例早期贲门腺癌患者的自然生存状况追踪分析

背景与目的:未经治疗的晚期贲门腺癌患者的生存时间为8～9个月.本研究目的是观察未进行任何治疗的早期胃贲门腺癌的自然发展史.方法:1987年在食管癌高发现场,对细胞学诊断为鳞状细胞重度增生的851例进行了内镜复查,同时检查了贲门区粘膜,经活检病理确诊为贲门腺癌者共43例.包括晚期癌12例,早期癌31例.其中17例早期患者虽经多次劝说,仍因不同原因拒绝治疗,随诊观察14年,直至全部患者死亡.结果:随诊14年,17例早期贲门癌患者中,12例死于贲门腺癌,另外5例死于非癌疾病;生存5年以上者13例,5年自然生存率为76.47%(13/17),10年自然生存率为23.53%(4/17).结论:早期贲门癌发展到晚期是一个漫长的演进过程.这对早期诊断和选择治疗时机很有帮助.同时,如要精确评估早期癌治疗效果,宜充分考虑其自然史的因素.

Natural progression of early stage adenocarcinoma of gastric cardia: a report of seventeen cases

BACKGROUND & OBJECTIVE: The survival time of untreated advanced gastric cardiac adenocarcinoma patients is about 8-9 months. This study was to observe the natural progression of untreated early stage gastric cardiac adenocarcinoma. METHODS: In 1987, at a high risk area of esophageal cancer, 851 patients with a previous cytologic diagnosis of esophageal dysplasia were re-examined by endoscopy, and 43 of them were diagnosed histologically as gastric cardiac adenocarcinoma. Of the 43 patients, 31 had early stage tumors, 12 had advanced tumors. The 17 early stage patients who refused treatment were followed up for 14 years till death. RESULTS: Of the 17 untreated patients, 12 were died of gastric cardiac adenocarcinoma, 5 were died of non-cancer diseases; 13 had survived for over 5 years. The 5-year natural survival rate was 76.47%; the 10-year natural survival rate was 23.53%. CONCLUSIONS: The progression of early stage cardiac cancer to advanced cancer is a very slow and long process, which is very helpful for early diagnosis and choice of therapeutic timing. The therapeutic effect on early stage cardiac cancer should be assessed with consideration of the natural history of this disease.