食管癌前病变阻断性治疗的远期效果

Long term effect of treating patients with precancerous lesions of the esophagus

目的 在食管癌高发区河南林县，观察食管癌前病变药物阻断性治疗的远期效果。方法 增生平片和维胺酯服用５ 年后，使食管重增的癌变率分别下降了５２．２ ％ 和４３．２％ 。为了验证它们阻断治疗的远期效果，进行了停药观察。核黄素服用５ 年后，使轻增的癌变率下降了３４．８％ ，与对照组相比，差异无显著性。继续服用核黄素，观察其长期阻断效果。结果 阻断治疗９ 年（ 服药５ 年，停药４ 年） 后食管细胞学复查，结果显示增生平片和维胺酯对重增人群癌变的抑制率仍保持为４２．１％和３８ ．２ ％ 。核黄素服用９ 年后，使轻增癌变率减少了３７．０ ％ ，与对照组相比，差异有非常显著性，证实了核黄素预防食管癌的作用。结论 食管癌前病变的药物阻断性治疗是一条有希望。

Objective To report long term therapeutic effect in patients with esophageal pre cancerous lesions in high risk area of esophageal cancer. Methods The therapeutic trial enrolled 2 531 cases of severe dysplasia and 3 393 cases of mild dysplasia. A 2 arm randomized, placebo controlled design was used in which the participants received Zeng Sheng Ping (ZSP, an herbal composite), retinamide or placebo for cases with severe dysplasia and riboflavin or placebo for those with mild dysplasia. Results Treatment with ZSP and retinamide decreased malignant transformation rate of severe dysplasia by 52.2% and 43.2%, respectively after 5 years of treatment. When the treatment had been discontinued for 4 years, the rate of malignat transformation was decreased by 42.1% and 38.2% respectively, which remained significantly higher than that of the placebo treated control. Riboflavin treatment was continued for 9 years. At the end of 5 year medication, the malignant transformation rate decreased by 34.8%, which was not significantly different from that of the placebo control. When the treatment was continued up to 9 years, the rate was further decreased to 37.0%, which became statistically significant.Conclusion ZSP, retinamide and riboflavin treatment can effectively prevent esophageal dysplasia from transforming into carcinoma.