内镜短期内重复筛查观察食管和贲门癌癌前自然史301例

Sojourn time observation of esophageal and cardia precancerous lesions by periodic endoscopic screening of 301 subjects in Shexian

目的：了解进展较快的食管和贲门癌前病变的时间，为寻找合适的筛查间隔提供线索。方法：在食管癌高发区河北涉县对40-69岁人群开展重复的内镜筛查。结果：301例重复筛查共观察到40例病情发生进展者，其中7例重度不典型增生中：1例首检为正常。间隔13个月检出重度不典型增生，1例首检为基底细胞增生，间隔7个月检出，4例首检为轻度不典型增生，分别间隔3个月、4个月、4个月、10．5个月检出。1例首检为中度不典型增生，间隔12．5个月检出；6例原位癌及黏膜内癌中：1例首检为轻度不典型增生，间隔48个月检出，2例中度不典型增生分别间隔4个月、13个月检出2例，3例重度不典型增生分别间隔3．5个月、9个月、17．5个月检出；3例浸润性癌中：1例中度不典型增生，间隔50个月检出、2例重度不典型增生间隔14个月和19个月检出。结论：食管和贲门癌前病变的滞留时间变异较大，有必要适当缩短筛查间隔，通过及时复查捕获那些进展较快、多点起源和首检遗漏的癌前病变。

Aim： To investigate sojourn time of rapid developing esophageal and cardia precancerous lesions. Methods：Periodic endoscopic screening was performed among 301 residents aged from 40 to 69 years in the high-incidence areas for esophageal cancer in Shexian, Hebei province. Results： Sojourn time for severe dysplasia （SD） was： 13 months after a baseline diagnosis of normal epithelium in 1 subject, 7 months after a baseline diagnosis of base cell hyperplasia（BCH） in 1 subject, 3 months, 4 months, 4 months, and 10.5 months after baseline diagnoses of mind dysplasia（mD） in 4 subjects, and 12.5 months after a baseline diagnosis of moderate dysplasia （MD） in 1 subject; Sojourn time for cancer in situ or intramucosal carcinoma was： 48 months after a baseline diagnosis of mD in 1 subject, 4 months and 13 months after baseline diagnoses of MD in 2 subjects, and 3.5 months, 9 months, and 17.5 months after baseline diagnoses of SD; and sojourn time for invasive cancer was： 50 months after a baseline diagnosis of MD in 1 subject, 14 months and 19 months after baseline diagnoses of SD in 2 subjects. Conclusion： Periodic screening with shorter intervals should be considered to control the number of interval cases due to rapid development, muhifocal carcinogenesis, and false negative results in endoscopic biopsy sampling.