食管癌在食管黏膜上最初起源点的高发现场前瞻性研究

A Prospective study of the origin of esophageal squamous cell carcinoma in the esophageal mucosa： result from a high risk area of esophageal cancer in China during a 15-year follow up （1987-2002）

目的探讨食管黏膜白脊与食管癌发生的关系，以及食管癌病灶的最初起源点。方法以1987年河南省林州市食管癌高发现场内镜筛查发现的339例有食管黏膜白脊或白脊背伴有红区和糜烂灶者作为研究组，以同期212例无白脊和活检病灶报告阴性者作为对照组，随访15年。以食管癌的发生为终点事件，比较两组的癌变率。结果339例有白脊者中，单纯白脊76例，白脊背有红区和糜烂灶者263例。随访15年，76例单纯白脊者中，癌变9例，癌变率为11．8％；263例白脊背有红区或糜烂灶者中，癌变88例，癌变率为33．5％。对照组212例中，17例发生食管鳞状细胞癌，癌发生率为8．0％。结论食管黏膜白脊与食管癌发生有密切关系，可能是食管癌最初起源点。白脊背出现红色糜烂灶，应视为癌前病变，定期内镜随诊。

Objective The aim of this study was to observe the association between the occurrence of esophageal cancer lesions and esophageal mucosa fold （ white ridges）, and further identify where is the initial origin of esophageal cancer lesions in the esophagus mucosa. Methods This was a cohort study which recruited 551 subjects underwent endoscopic examination in a high risk area of esophageal cancer in Linxian, Henan Province in 1987. 339 subjects with esophageal white ridges, and with red area or erosion lesion at the surface of the white ridges, was studied as exposure group. Other 212 subjects whose esophagus had no white ridges and pathological diagnosis was negative, was studied as control group. The endpoint was occurrence of pathologically confirmed esophageal cancer. After a 15-year follow-up, the results were compared between two groups. Results Among the 551 subjects, there were 339 cases with esophageal mucosal white ridges in the exposure group. During the period of 15 year follow-up, the incidence of esophageal cancer was 11.8% （9/76） in 76 case with simple mucosal white ridges, 33.5% （88/263） in 263 subjects with white ridges and red area, or erosions on the surface of white ridge. While only 8.0% of subjects （17/212） developed esophageal cancer after the 15-year follow up in the control group. There was a significant difference between the two groups （ P 〈 0.001 ）. Conclusion Esophageal mucosal white ridge, especially white ridge with red area or erosions is closely associated with subsequent esophageal cancer occurrence in the esophageal cancer high risk area in China. It is suggested that esophageal mucosa with white ridge may be the initial origin of esophageal cancer. Further investigations focused on this spot are required.