口服补钙对食管癌前疾患是否有影响──双盲干预试验研究

本文对食管癌高发区辉县居民的癌前疾患进行了随机双盲钙干预治疗研究。服药一年后，不论是钙剂（服碳酸钙）治疗组，还是对照组，食管上皮基底细胞增生及炎症状况均有改善，包括内镜、组织学及放射自显影三项指标，两组统计学上未见区别（Ｐ＞０．０５），治疗后的血钙水平两组亦无差异（Ｐ＞０．０５）。由此可见，口服补钙不能对食管癌起到预防作用，对食管癌癌前疾患治疗无效。     

Proliferation of esophageal epithelial cells among residents of Linxian, People's Republic of China

Histopathologic and tritiated thymidine labeling subjects were carried out on esophageal biopsy specimens of 44 human subjects with cytologic evidence of dysplasia from Linxian, People's Republic of China, a high-risk area for esophageal cancer. With the use of histopathologic criteria, 10 cases showed evidence of dysplasia, 20 hyperplasia, and 14 a near-normal morphology when compared with 21 normal cases studied previously from Jiaoxian, a low-risk area for esophageal cancer in the People's Republic of China. Significantly increased labeling indices were found in the esophageal mucosa of the dysplasia and hyperplasia subjects. There was a gradient of increased expansion in the basal layer of proliferating cells progressing from normal to hyperplasia to dysplasia, with the expansion twice as high in the epithelial cell lining in dysplasia when compared with the findings in the normal and near-normal groups. The correlation of proliferative abnormalities with the severity of precancerous lesions of the esophagus indicates that labeling studies may provide a sensitive adjunct to evaluate risk status and any modifications that might result from nutritional intervention.     

Effect of added dietary calcium on esophageal epithelial-cell proliferation in subjects at high risk for esophageal cancer: A double-blind intervention study

A randomized double-blind intervention trial was carried determine whether oral calcium supplementation could lower the proliferation of epithelial cells of the esophagus. 41 subjects identified with precanceous lesions by histopathology were randomized to receive oral supplementation of their conventional diets with 0.6 g of calcium as calcium carbonate or placebo. Both at the entry to the study and at the end of the treatment, seven months later, the subjects were examined, with an emphasis on the frequency and distribution of proliferating epithelial cells of the esophagus. Patterns of cell proliferation was defined by dividing the esophageal epithelium into cell olumns oriented perpendicularly to the basal cell layer and by comparing the numbers and fractions of tritiated thymidine-labled epithelial cells in the various cell columns and cell compartments. Before dietary supplementation with calcium, the profile of proliferating epithelial cells in the esophageal compartments in calcium group is similar to that in the placebo group, which is comparable to that previously observed in subjects with high risk for esophageal cancer. Seven months after supplementation having been started, in calcium group, proliferation was significantly reduced and the profile of the esophageal columns approached to that previously observed in subjects at low risk for esophageal cancer, however, in the placebo group, the proliferation and profile maintain at the same level as that before supplementation. Our findings indicate that oral calcium supplementation induces a more quiescent equilibrium in epithelial-cell proliferation in the esophageal mucosa of the subjects at high-risk for esophageal cancer, similar to that observed in subjects at low risk.     

食管癌旁上皮及原位癌中p53蛋白的表达及意义

目的 :探讨食管癌旁正常上皮、增生上皮、不典型增生上皮及原位癌中抑癌基因p5 3蛋白的异常表达情况及其意义。方法 :用HE染色确定上皮类型。用免疫组化LSAB法检测各种癌旁上皮及原位癌中p5 3蛋白的表达。结果 :正常粘膜上皮中无p5 3蛋白的积聚。增生上皮p5 3蛋白阳性率为 5 5 %,但阳性细胞少 ,染色浅。不典型增生上皮p5 3蛋白阳性率为79 %,且阳性细胞逐渐增多 ,染色加深 ;原位癌中p5 3蛋白阳性率为 98%。三者之间经 χ2 检验差异有显著性 (P <0 0 1)。结论 :p5 3蛋白积聚在食管上皮癌变前即已存在 ,在原位癌中积聚更加显著。可以作为上皮恶性转化的客观指标之一。     

山东省肥城市2006-2012年676例食管癌前病变内镜筛查结果分析

[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。     

有癌和无癌家族史青年人食管上皮癌前病变的研究

本文报告食管癌高发区15～25岁有癌和无癌家族史青少年人食管上皮癌前病变的对比研究。其中,有癌家族史者148人,无癌家族史者272人。前者食管上皮乳头升高,中性粒细胞浸润,不全角化,基底细胞增生和间变的发生率(%)男性为42.69、12.36、1.12,3.37和1.12;女性为32.2,8.47,1.69,5.08和0。无癌家族史青年人的发生率(%)男性为27.22,7.22,6.67,5.55和0.56;女性为28.26,10.8 6,5.43,1.67和0。有癌家族史青年人食管粘膜上皮异常发生率和乳头升高发生率明显高于无癌家族史青年人(P<0.05)。女性有癌家族史青年人基底细胞增生率高于无癌家族史青年人;提示食管癌前病变的发生有家族倾向性。     

食管癌高发区山东省肥城市2006年至2016年食管癌前病变转归情况分析

  目的  研究食管癌高发区中国山东省肥城市食管癌前病变自然转归情况，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  回顾性收集山东省肥城市2006年至2016年期间进行内镜病理诊断且未治疗并进行二次内镜随访的受检者资料进行分析，描述癌前病变病例的具体复查结果，计算进展病例的累积进展率和进展时间，分析食管癌前病变病例的转归情况。  结果  本研究共纳入1 834例食管癌前病变病例，其中1 148例（62.6%）癌前病变发生逆转，148例（8.1%）发生进展。逆转为正常状态的病例共234例（12.8%），进展为食管癌共17例（0.9%）。各级别癌前病变进展为食管癌的病例比例由高至低依次为:重度异型增生/原位癌（4.9%）、中度异型增生（1.3%）、轻度异型增生（0.2%）；其发生癌变的中位进展时间由高至低依次为:轻度异型增生（5.62年）、中度异型增生（1.76年）和重度异型增生/原位癌（1.61年）。轻度异型增生9年累积进展为重度异型增生/原位癌及以上的进展率远小于中度异型增生（1.81% vs.9.98%），重度异型增生/原位癌进展为食管癌的累积进展率始终高于中度和轻度异型增生。  结论  超过一半以上的癌前病变会逆转为较低级别病变或正常状态；食管癌前病变的累积癌变率随病变级别的增高而增大，中位进展时间随病变级别的增高而缩短。大多数癌前病变进展为食管癌的时间间隔基本与《癌症早诊早治上消化道癌筛查及早诊早治技术方案》中的随访间隔相符，可适当对轻度异型增生患者的随访间隔缩短为每2年1次。      

Histogenesis of esophageal carcinoma]

Histopathologic and tritiated thymidine labelled autoradiography was carried out on 206 human esophageal biopsy specimens obtained in Linxian county, a high risk area of esophageal cancer in China. According to the histopathologic criteria, 6 cases showed atrophy, 151 normal, 31 hyperplasia, 14 dysplasia and 4 carcinoma. The index of labeled cells were: atrophy 3.3, normal 4.73, hyperplasia 4.9, dysplasia 5.6, carcinoma in situ 11.76 and invasive carcinoma 24.63. Significant increase in labeling was found in the esophageal mucosa with hyperplasia, dysplasia and carcinoma. There was a gradient of increased expansion in the basal layer as the proliferating cells progress from normal to hyperplasia, to dysplasia, and to carcinoma. These results show that the hyperplastic and dysplastic cells were fundamental phases of carcinomatous change in the esophageal mucosa. It shows a wide spectrum of cellular alterations in the course of malignant change and the close relationship between the morphological alterations and cell biology.     

磁县食管癌高发区高危人群食管癌前状态及病变分析

  目的  了解磁县食管癌高发区居民食管癌前状态及病变的分布情况,为该病的病因及二级预防提供依据。   方法  收集磁县2005年1月至2009年12月完成的40~69岁人群的食管癌早诊早治内镜筛查资料,筛查采用内镜碘染色指示性活检,并对符合对象按性别、年龄组统计食管癌癌前状态及病变的检出率。   结果  纳入分析队列筛查对象11 423例,食管活检率66.90%。食管鳞状上皮轻度、中度、重度异型增生检出率分别为11.84%、2.66%、1.04%,原位癌检出率为0.40%,鳞癌可能有浸润的患者检出率为0.04%、黏膜内鳞状细胞癌为0.37%,浸润性鳞癌为0.17%。平均重度异型增生以上及癌的检出率为2.01%。   结论  磁县食管癌高发区40~69岁人群存在大量无症状癌前病变及癌症患者,年龄和性别与检出率关系密切。      

肥城市农村居民食管癌及癌前病变危险因素多元有序Logistic回归分析

目的食管癌是常见的消化道恶性肿瘤,山东省肥城市是我国食管癌高发地区之一。探讨山东省肥城市农村居民食管癌及癌前病变发生的危险因素,为当地食管癌的防治工作提供依据。方法以2013年在"国家食管癌早诊早治示范基地(山东省肥城市)"参与上消化道癌症筛查,并进入食管癌筛查与随访社区人群队列的40~69岁农村居民为研究对象,内镜下碘染色及病理活检结果作为诊断依据,依据诊断标准将其分为不同病变等级,进行问卷调查,并采用多元有序Logistic回归分析食管癌及癌前病变的危险因素。结果共纳入食管正常人1910名、轻度增生511例、中度增生130例、重度增生及以上100例。多元有序Logistic回归分析结果显示,年龄(OR=1.09,95%CI:1.08~1.11)、饮酒(OR=1.45,95%CI:1.13~1.86)、饮茶(OR=1.39,95%CI:1.15~1.68)、燃煤取暖(OR=1.43,95%CI:1.10~1.85)及肿瘤家族史(OR=1.35,95%CI:1.11~1.66)是食管癌及癌前病变发生的独立危险因素,P<0.05。结论年龄、饮酒、饮茶、燃煤取暖及肿瘤家族史是肥城市农村居民食管癌及癌前病变的危险因素,改变不良生活方式有利于做好食管癌的防治工作。