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Risk factors for neoplastic progression in Barrett's esophagus

World Journal of Gastroenterology 2011年第32期17卷 3672-3683页

作者： Elizabeth F Wiseman Yeng S Ang Department of Gastroenterology Royal Albert Edward Infirmary Wigan Lane Wigan Greater Manchester WN1 2NN United Kingdom Faculty of Medical and Human Sciences School of Translational Medicine The University of Manchester Oxford Road Manchester M13 9PL United Kingdom

Barrett's esophagus (BE) confers a significant increased risk for development of esophageal adenocarcinoma (EAC), with the pathogenesis appearing to progress through a "metaplasia-dysplasia-carcinoma" (MDC) sequence. Many of the genetic insults driving this MDC sequence have recently been characterized, providing targets for candidate biomarkers with potential clinical utility to stratify risk in individual patients. Many clinical risk factors have been investigated, and associations with a variety of genetic, specific gastrointestinal and other modifiable factors have been proposed in the literature. This review summarizes the current understanding of the mechanisms involved in neoplastic progression of BE to EAC and critically appraises the relative roles and contributions of these putative risk factors from the published evidence currently available.

关键词： Barrett’s esophagus esophageal adeno-carcinoma Metaplasia-dysplasia-carcinoma Neoplastic progression Risk factors

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Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma

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World Journal of Gastroenterology 2008年第20期14卷 3165-3173页

作者： Deirdre P Cronin-Fenton Margaret M Mooney Limin X Clegg Linda C Harlan Surveillance Research Program DCCPS National Cancer Institute CTEP DCTD National Cancer Institute Applied Research Program DCCPS National Cancer Institute

AIM： TO examine the extent of use of specific therapies in clinical practice, and their relationship to therapies validated in clinical trials. METHODS： The US National Cancer Institutes＇ Patterns of Care study was used to examine therapies and survival of patients diagnosed in 2001 with histologically-confirmed gastroesophageal adenocarcinoma （/7 = 1356）. The study re-abstracted data and verified therapy with treating physicians for a population-based stratified random sample. RESULTS： Approximately 62% of patients had stomach adenocarcinoma （SAC）, while 22% had gastric-cardia adenocarcinoma （GCA）, and 16% lower esophageal adenocarcinoma （EAC）. Stage 1V/ unstaged esophageal cancer patients were most likely and stage Ⅰ -Ⅲ stomach cancer patients least likely to receive chemotherapy as all or part of their therapy; gastric-cardia patients received chemotherapy at a rate between these two. In multivariable analysis by anatomic site, patients 70 years and older were significantly less likely than younger patients to receive chemotherapy alone or chemoradiation for all three anatomic sites. Among esophageal and stomach cancer patients, receipt of chemotherapy was associated with lower mortality; but no association was found among gastric-cardia patients. CONCLUSION： This study highlights the relatively low use of clinical trials-validated anti-cancer therapies in community practice. Use of chemotherapy-based treatment was associated with lower mortality, dependent on anatomic site. Findings suggest that physicians treat lower esophageal and SAC as two distinct entities, while gastric-cardia patients receive a mix of the treatment strategies employed for the two other sites.

关键词： adenocarcinoma esophageal adeno-carcinoma Gastroesophageal Gastric adenocarcinoma Survival Chemotherapy Radiotherapy

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Indomethacin but not a selective cyclooxygenase-2 inhibitor inhibits esophageal adenocarcinogenesis in rats

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World Journal of Gastroenterology 2012年第35期18卷 4866-4874页

作者： Paula Esquivias Antonio Morandeira Alfredo Escartín Carmelo Cebrián Sonia Santander Francisco Esteva María Asunción García-González Javier Ortego Angel Lanas Elena Piazuelo CIBER Digestive and Hepatic Deseases Service of Surgery University Hospital "Lozano Blesa" Service of Pathology University Hospital "Lozano Blesa" Department of Medicine University of Zaragoza Service of Clinical Biochemistry University Hospital "Lozano Blesa" Aragon Health Science Institute Service of Gastroenterology University Hospital "Lozano Blesa"

AIM： To evaluate the effects of indomethacin [dual cyclooxygenase （COX）-I/COX-2 inhibitor] and 3-（3,4-difluorophenyl）-4-（4-（methylsulfonyl） phenyl）- 2-（5H）-furanone （MF-tricyclic）（COX-2 selective inhibi- tor） in a rat experimental model of Barrett＇s esophagus and esophageal ***： A total of 112 surviving post-surgery rats were randomly divided into three groups： the control group （n = 48）, which did not receive any treatment; the indomethacin group （n = 32）, which were given 2 mg/kg per day of the COX-I/COX-2 inhibitor; and the MF-tricyclic group （n = 32）, which received 10 mg/kg per day of the selective COX-2 inhibitor. Randomly se- lected rats were killed either 8 wk or 16 wk after sur- gery. The timing of the deaths was in accordance with a previous study performed in our group. Only rats that were killed at the times designated by the protocol were included in the study. We then assessed the histology and prostaglandin E2 （PGE2） expression levels in the rat esophagi. An additional group of eight animals that did not undergo esophagojejunostomy were included in order to obtain normal esophageal tissue as a control. RESULTS： Compared to a control group with no treat- ment （vehicle-treated rats）, indomethacin treatment was associated with decreases in ulcerated esophageal mucosa （16% vs 35% and 14% vs 17%, 2 mo and 4 mo after surgery, respectively; P = 0.021）, length of intestinal metaplasia in continuity with anastomosis （2 4- 1.17 mm vs 2.29 ＋ 0.75 mm and 1.25 4- 0.42 mm vs 3.5 4- 1.54 mm, 2 mo and 4 mo after surgery, respec- tively; P = 0.007）, presence of intestinal metaplasia beyond anastomosis （20% vs 71.4% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P = 0.009）, severity of dysplasia （0% vs 71.4% and 20% vs 85.7% high-grade dysplasia, 2 mo and 4 mo after surgery, re- spectively; P = 0.002）, and adenocarcinoma incidence （0% vs 57.1% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P 〈 0.0001）. Treatment with the select

关键词： Intestinal metaplasia esophageal adeno-carcinoma Indomethacin MF-tricyclic

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