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[目的]研究食管癌高发地区食管癌前病变转归情况及其影响因素,为食管癌前病变及食管鳞癌的防治工作提供科学依据。[方法]采用历史性队列研究方法对山东省肥城市2006-2012年期间接受筛查未治疗,并进行病理检查随访的受检者资料进行分析,描述首检及随访筛检结果,分析影响癌前病变发生、发展的因素。[结果]676例首检者接受随访,筛检结果为417例(61.7%)发生逆转,157例(23.2%)保持稳定,102例(15.1%)发生进展。102例进展者的病理诊断结果分别为9例食管炎,26例轻度异型增生,27例中度异型增生,30例重度异型增生原位癌,10例食管癌。其中基底细胞增生平均间隔为2.7年,随访结果为食管癌,轻度异常增生为6.3年,中度异常增生为2.9年,重度异型增生/原位癌为1.0年。男性、饮酒、饮茶为癌前病变发生、发展的危险因素,其OR值和95%CI值分别为1.712(1.088~2.694)、1.611(1.058~2.453)、1.784(1.004~3.170);年龄<55岁为癌前病变发生、发展的保护因素。[结论]首检后对基底细胞增生和轻度异型增生应间隔2年复查一次,对中度异型增生和未治疗的重度异型增生/原位癌应间隔半年复查一次,以减少早期癌的漏诊率;对男性、年龄≥55岁、饮酒、饮茶的癌前病变人群应加强筛查力度。 相似文献
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目的:分析食管癌高发区40-69岁农村居民食管癌内镜筛查结果,探讨食管癌及各级癌前病变的患病及早诊早治情况。方法:2012-2016年在食管癌高发区四川省阆中市采取整群随机抽样的方法,选择行政自然村为基本单元,以全部40-69岁当地农村居民作为筛查对象,对其进行上消化道内镜检查并进行碘染色及指示性活检,以组织病理学诊断作为最终确诊。结果:2012~2016年阆中市的18个乡镇共筛查40~69岁农村居民10102例,各级食管病变检出率为22.73%(2296/10102),食管阳性病例检出率为1.77%(179/10102),食管癌前病变检出率为5.49% (555/10102)。男性食管各级病变总体检出率以及食管癌前病变、阳性病例的检出率分别高于女性(9.36%vs.5.44%, 7.03%vs.4.06%, 2.34%vs.1.37%);男性食管轻度异型增生、中度异型增生、重度异型增生/原位癌以及食管浸润癌的检出率均分别高于女性(5.81%vs.3.42%, 1.22%vs.0.64%, 1.83%vs.1.17%, 0.38%vs.0.14%),差异有统计学意义(均P<0.05)。食管各级病变总体检出率、食管癌前病变、阳性病例的检出率以及食管轻度异型增生、中度异型增生、重度异型增生/原位癌的检出率均随着年龄的增长呈逐渐升高的趋势,60岁以后增长明显,差异均有统计学意义(均P<0.05)。结论:阆中市食管癌高发区农村居民食管癌内镜筛查及早诊早治工作已初步显示出良好的效果,应重视癌前病变患者的早期诊断、治疗与随访。 相似文献
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目的了解四川省南部县食管癌筛查情况,为进一步提高食管癌及癌前病变早期检出率提供科学依据。方法在四川省南部县食管癌高发区,采取整群随机抽样的方法选择部分自然村,以行政村为单元从公安部门获取人口学资料,完成全人口注册登记,以40-69岁居民作为筛查对象,进行内镜下碘染色及指示性活检筛查,并经病理学最终诊断确诊。结果食管炎症及食管轻、中、重度异型增生的检出率分别为4.56%(639/14000)、6.09%(853/14000)、3.92%(549/14000)、0.74%(104/14000),食管浸润癌的检出率为0.31%(43/14000);各个级别食管病变的检出率男性均高于女性;各年龄段分析发现,轻中度异型增生检出率随着年龄升高而增高,重度异型增生/原位癌在50岁~和65岁~两个年龄组出现高发。结论在食管癌高发区人群中存在着相当数量的癌前病变患者,应对高危人群进行癌症综合知识宣传,提高防癌意识,做到食管癌的早发现、早诊断、早治疗。 相似文献
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目的:探索食管轻度和中度异型增生患者的疾病进展和转归情况。方法:纳入2015-2017年参加四川省上消化道癌筛查的居民中首次诊断为食管轻度和中度异型增生的患者共73例,整理纳入患者的基本信息、基线期及随访阶段病理结果,采用卡方检验比较进展率或转归率,Kaplan-Meier法计算中位时间。结果:食管轻度异型增生患者与中度异型增生患者的疾病转归率无统计学差异(73.17% VS 68.75%,P=0.68);食管轻度异型增生患者与中度异型增生患者的疾病进展率无明显差异(12.20% VS 18.75%,P=0.44);轻度异型增生的转归时间显著长于中度异型增生(16.60月 VS 11.17月,P<0.001),轻度异型增生的进展中位时间与中度异型增生无统计学差异(14.60月 VS 13.00月,P=0.122)。结论:食管轻度和中度异型增生的进展率和转归率均无明显差异,但其疾病转归的时间存在明显不同。 相似文献
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目的淮安市自2009年开始被纳入国家卫生计生委中央转移支付肿瘤随访登记项目点。本研究旨通过分析2009-2017年淮安市食管癌早诊早治项目筛查结果,探讨高危人群食管癌及癌前病变的流行特征,为全市食管癌综合防治提供科学依据。方法2009-2017年在淮河流域癌症早诊早治项目点洪泽、金湖和涟水三地,采用健康危险因素调查筛选高危人群,进行食管内镜碘染色指示性活检,由病理诊断最终确诊,对发现的食管癌及癌前病变患者及时开展治疗,筛查结果按年份、性别、年龄组等进行统计描述,各级食管病变的检出率、早诊率比较采用χ^2检验。结果全市共完成高危人群筛查31650人,男女比例为1∶1.34,平均年龄为(55.15±7.77)岁,取病理活检6473例,活检率为20.45%,其中癌前病变检出率为5.27%(1666/31650),阳性病例检出率为1.24%(392/31650),早诊率为89.80%(352/392)。食管轻度异型增生、中度异型增生、重度异型增生/原位癌、早期癌和浸润癌的检出率分别为4.37%(1382/31650)、0.90%(284/31650)、0.93%(294/31650)、0.18%(58/31650)和0.13%(40/31650)。除浸润性癌外,男性其他食管病变检出率均高于女性,χ^2=6.815,P=0.009;各级食管病变的检出率随着年龄的增加而上升,χ^2趋势=17.003,P=0.001。结论淮安市食管癌内镜筛查及早诊早治工作已取得良好的效果,但在高发区人群中仍存在大量的食管早期癌和癌前病变者,应进一步加强食管早期癌和癌前病变人群随访和干预工作,以降低食管癌发病率和死亡率。 相似文献
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目的 将治疗大鼠骨髓增生异常综合征(MDS)和红白血病所用的V-erbB反基因寡核苷酸(ODN,B1和B2)粉针剂应用于高发区食管癌早期和食管原位癌患者的基因治疗.方法 应用两种治疗方案,即第1方案(B1+B2)和第2方案(B1+B2+CpG),分别对41例食管上皮非典型增生(中度增生15例,重度增生26例)及5例食管原位癌患者,在内窥镜下进行局部喷洒药物治疗,隔日1次,连续3次为1个疗程.1~2个月后复查和病理检查.并于治疗后5年进行随访复查.结果 41例食管上皮非典型增生患者应用第1方案治疗,其中33例从中度增生或重度增生逆转为轻度增生或正常,有效率为80.5%.8例无效,其中1例进展为原位癌.第2方案治疗5例原位癌,3例有效(1例逆转为重度增生.1例逆转为轻度增生,1例逆转为轻度食管炎),2例无效.治疗后5年随访,84.2%患者已痊愈.结论 上述两个治疗方案对高发区癌症的二级预防意义重大. 相似文献
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[目的]分析2009-2012年武威市凉州区上消化道癌(食管癌、胃癌)筛查情况。[方法]采用流行病学调查、血清PG检测、内镜活检和病理检查的方法,对武威市凉州区40-69岁无症状、有上消化道病史、食管癌和胃癌家族史志愿者进行上消化道癌筛查。[结果]本组筛查共8007人,上消化道癌总检出率为1.80%(144/8007),食管癌检出率为0.54%(43/8007),胃癌检出率为1.26%(101/8007)。上消化道癌早诊率为72.22%(104/144)。2009-2010年PG检测3507人,PG阳性组(n=1307)中胃癌和高级别上皮内瘤变检出率分别为0.84%(11/1307)、0.31%(4/1307);而PG阴性组中(n=2200)则分别为0.36%(8/2200)、0.14%(3/2200)。PG阳性与PG阴性组间胃癌及其癌前病变检出率差异有显著性(P〈0.01)。3507人检出重度异型增生/原位癌及食管癌14例,其中PG阴性检出食管癌4例,重度异型增生/原位癌2例;PG阳性组中检出食管癌4例,重度异型增生/原位癌4例。[结论]在上消化道癌高发区直接应用内镜对上消化道癌进行筛查,才能最大限度地降低上消化道癌的漏诊。 相似文献
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宋钰罗静张渊徐德陈秋余 《肿瘤预防与治疗》2018,31(4):263-267
目的:分析黏膜切除术前、术后病理诊断符合率,探讨黏膜切除术后病理在食管癌前病变及早期食管癌诊断中的价值,为食管癌的早期诊断及治疗提供相关依据。方法:回顾性收集2013年1月至2017年6月巴中市中心医院收治100例行内镜下黏膜切除术患者,比较术前活检病理诊断与术后病理诊断的一致率及差异性,分析黏膜切除术后病理对食管癌前病变及早期食管癌的诊断价值。结果:活检病理与术后病理诊断符合率为42.06%(45/107),诊断不足(病情被低估)率为41.12%(44/107),诊断过度(病情被高估)率为16.82%(18/107)。轻度异型增生诊断符合率为10%(1/10),诊断不足率为90%(9/10);中度异型增生诊断符合率为17.65%(3/17),诊断不足率为23.53%(4/17),诊断过度率为58.82%(10/17);重度异型增生诊断符合率为38.98%(23/59),诊断不足率为90%(11/59),诊断过度率为18.64%(25/59);早期浸润癌诊断符合率为85.71%(18/21),诊断过度率为14.29%(3/21)。重度异型增生和早期浸润癌患者的平均最大病变直径分别高于轻度异型增生组,早期浸润癌患者的平均最大病变直径高于中度异型增生组,差异有统计学意义(P<0.0083)。结论:内镜下黏膜切除术后病理诊断食管癌前病变及早期食管癌病变性质的准确性更高,但鉴于食管癌癌前病变及早期食管癌病理过程及形态的复杂性,在内镜活检结合术后病理诊断的同时,应参考内镜下表现来制定合理的临床诊疗方案。 相似文献
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应用内镜下碘染色在食管癌高发区进行普查的意义 总被引:35,自引:0,他引:35
背景与目的:食管癌的死亡率一直居高不下,主要是由于其早诊率较低。为提高食管癌的早诊率,本研究探讨在我国食管癌高发区应用直接内镜下碘染色进行普查提高食管癌早诊率的可行性。方法:应用直接内镜下碘染色在我国食管癌高发区对3164名高危人群进行3次普查,每个普查对象均在着色区取一块活检组织,且每例可疑病例也均在食管的不着色区取活检组织作病理检查,然后将食管鳞状上皮的着色情况与其对应的病理检查结果进行对照。结果:(1)早期食管癌100%碘染色阳性,染色级别多为I级。早期食管癌检出率为1.6%-4.59%,中晚期食管癌的检出率为0.29%-1.09%,食管癌的早诊率均在75%以上。(2)食管鳞状上皮重度不典型增生95.6碘染色阳性,其中91.3%病例碘染色级别为I和Ⅱ级。食管鳞状上皮重度不典型增生检出率为4.49%-7.68%。(3)中度不典型增生96.6%碘染色阳性,73.3%病变染色级别为Ⅱ和Ⅲ级。(4)92.3%轻度不典型增生碘染色阳性,86.5%病变染色级别为Ⅱ和Ⅲ级。(5)而只有0.9%的炎症和0.4%的正常组织碘染色级别为I和Ⅱ级,正常组织大多数为阴性或Ⅲ级。结论:在食管癌高发区应用直接内镜下碘染色进行普查,对早期食管癌及其癌前病变有较高的检出率。 相似文献
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Jiace Qin Yanyan Zhu Yongwei Ding Tingting Niu Yangyang Zhang Huiting Wu Lili Zhu Baoyin Yuan Yan Qiao Jing Lu Kangdong Liu Ziming Dong Ge Jin Xinhuan Chen Jimin Zhao 《Neoplasia (New York, N.Y.)》2021,23(7):663
Esophageal mucosa undergoes mild, moderate, severe dysplasia, and other precancerous lesions and eventually develops into carcinoma in situ, and understanding the developmental progress of esophageal precancerous lesions is beneficial to prevent them from developing into cancer. DNA polymerase β (Polβ), a crucial enzyme of the base excision repair system, plays an important role in repairing damaged DNA and maintaining genomic stability. Abnormal expression or deletion mutation of Polβ is related to the occurrence of esophageal cancer, but the role of Polβ deficiency in the esophageal precancerous lesions is still unclear. Here, esophageal mucosa Polβ-knockout mice were used to explore the relationship of Polβ deficiency with esophageal precancerous lesions. First, we found the degree and number of esophageal precancerous lesions in Polβ-KO mice were more serious than those in Polβ-Loxp mice after N-nitrosomethylbenzylamine (NMBA) treatment. Whole exome sequencing revealed that deletion of Polβ increased the frequency of gene mutations. Gene expression prolife analysis showed that the expression of proteins correlated to cell proliferation and the cell cycle was elevated in Polβ-KO mice. We also found that deletion of Polβ promoted the proliferation and clone formation as well as accelerated cell cycle progression of human immortalized esophageal epithelial cell line SHEE treated with NMBA. Our findings indicate that Polβ knockout promotes the occurrence of esophageal precancerous lesions. 相似文献
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Objective: To detect the changes of p16 and FHIT and investigate their relationship in esophageal squamous cell carcinoma development by measuring their expression levels in normal squamous epithelium tissue, mild, moderate, severe dysplasia lesions, carcinoma in situ and invasive squamous cell carcinomas. Methods: Expressions of p16 protein and FHIT protein were detected and analyzed in 17 cases of normal squamous epithelium, 16 cases of mild dysplasia, 16 cases of moderate dysplasia, 17 cases of severe dysplasia, 10 cases of carcinoma in situ, and 18 cases of esophageal squamous cell carcinoma by immunohistochemical method. Results: With increasing histopathologic grades, the expressions of pl6 and FHIT became gradually lower. There was no remarkable difference of p16 and FHIT expressions between the normal and mild dysplasia group (P〉0.05), but the differences between the normal and other groups were all significant (P〈0.05). There was no remarkable difference among the squamous cell carcinoma group, the moderate and severe dysplasia groups, and the carcinoma in situ group (P〉0.05), but significant differences existed in the expressions of p16 and FHIT proteins between the squamous cell carcinoma and the normal groups, and between the squamous cell carcinoma and the mild dysplasia groups (P〈0.05). There was an association of descending trend between p16 and FHIT protein expressions. Conclusion: Reduced expressions of pl6 and/or FHIT proteins possible play an important role in the early occurrence of esophageal cancer. There was a positive correlation between the expressions of p16 and FHIT proteins. 相似文献
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JunHou ZhifengChen CuilanGuo ShaosenLi WenlongBai GuolimngJin YuxiaWang FanshuMeng FengGao XujingLu ZhifangWang GangKuang 《中国肿瘤临床(英文版)》2004,1(1):27-31
OBJECTIVE To characterize the histologic types of esophageal cardiac mucosa by endoscopic survey in a high-risk cancer area of China. METHODS An endoscopic survey with Lugol,s staining was carried out in Cixian County, Hebei Province from December 2001 to May 2002. The data were processed using computer SPSS 10.0 software. RESULTS The incidences of mild esophagitis, moderate esophagitis, and severe esophagitis were for 2013 cases, 34.9%(703), 1.6%(33) and 0.1% (2)respectively; those with mild dysplasia, moderate dysplasia, severe dysplasia of the esophagus were 8.6% (172), 7.8% (157) and 2.6% (53) respectively; those with carcinoma in situ, intramucosal carcinoma, invasive squamous carcinoma of the esophagus were 2.5%(50), 0.2% (4) and 0.7%(14) respectively. The histologic-detecting rates of non-atrophic gastritis, and atrophic gastritis of the cardia were 36.3%(730), 11.5% (232) respectively; those with mild dysplasia, severe dysplasia of the cardia were 2.5%(51), 0.8%(17) respectively; those with intramucosal adenocarcinoma, invasive adenocarcinoma of the cardia were 0.1% (3), 0.8%(17) respectively. The early-detection rate of esophageal cancer was 79.4%(54/68). The survey rate(examined population to covered population) was 73.8% (2013/2725). CONCLUSIONS Esophageal endoscopic screening with Lugol‘s solution staining has an advantage over esophageal balloon cytology, in that the histological diagnoses of esophageal cardiac diseases can be obtained, thus contributing to the prevention of subsequent disease. In using the staining method the detection rate of early esophageal cancer is higher than that revealed by balloon cytology. 相似文献
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食管癌发生发展过程中环氧合酶-2蛋白表达的研究 总被引:27,自引:0,他引:27
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,探讨非类固醇抗炎药在食管癌高危人群中化学预防的可能性。方法 应用免疫组织化学方法检测120例食管癌(原位癌30例,鳞状细胞癌60例,腺癌30例)及其113例增生性病变(单纯增生29例,轻、中、重度不典型增生分别为31例、30例、23例)和27例正常食管黏膜鳞状上皮,以及3例Barrett食管组织中Cox-2蛋白的表达情况。结果 在正常食管黏膜上皮,单纯增生,轻、中、重度不典型增生,原位癌未发现有Cox-2蛋白表达;在6%(4/60)侵袭性鳞状细胞癌和70%(21/30)的食管腺癌中,Cox-2蛋白表达阳性。结论 Cox-2蛋白表达可能与食管腺癌的形成有关,而与鳞状细胞癌的发生发展无关。 相似文献