抗反流手术后复发增加食管腺癌风险

一项瑞典全国性数据库研究显示，抗反流手术后出现复发性反流的患者罹患食管腺癌的几率较手术成功患者增加2倍。

这项病例对照研究的数据来自瑞典癌症注册，共纳入1996~2006年间接受抗反流手术的295例患者，多数患者为男性(87%)。在7年随访期间，共有55例患者罹患食管腺癌。病例与对照人群的吸烟状况无显著差异(47% vs. 42%)。病例人群中的复发性反流较对照人群更常见，并具有统计学差异(35% vs. 18%)。

校正体重指数、吸烟状况和抗反流手术类型的多变量分析显示，复发性反流使之后发生食管腺癌的风险增加3倍。体重指数(BMI)超过25 kg/m2 也会增加风险，但无统计学意义[比值比(OR)为1.6；置信区间(CI)为0.8~3.5]。因BMI超过30 kg/m2 的患者很少，故无法进一步分析体重的影响。既往有吸烟史也会增加食道癌风险，但风险增高也无统计学意义(OR，1.4；CI，0.7~2.8)。与部分胃底折叠术相比，360度胃底折叠术与癌症风险较低相关，但差异也无统计学意义(OR，0.6；CI，0.3~1.3)。

主要研究者、斯德哥尔摩市卡罗琳斯卡医学院的Hedvig E. Lofdahl医生认为，“这一发现至少能部分解释抗反流手术为何缺乏癌症预防效应。”该研究提示，当抗反流手术效果不佳时，严密观察可能是预防癌症的关键。该研究发表于4月份的《外科学年鉴》(Ann. Surg. 2013;257:579-82)。

该研究由瑞典研究委员会、瑞典癌症学会和斯德哥尔摩癌症学会资助。作者均无相关利益冲突披露。

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By: MICHELE G. SULLIVAN, Oncology Practice

Patients who experience recurrent reflux despite surgical treatment are three times more likely to develop esophageal adenocarcinoma than are those who have a successful surgery.

The findings of a national database study suggest that careful observation may be key to prevention of cancer when antireflux surgery doesn’t deliver, reported Dr. Hedvig E. Lofdahl and colleagues. The study was published in the April issue of Annals of Surgery.

"From a clinical point of view, this study suggests that it might be valuable to carefully evaluate the result of the antireflux surgery, and consider the patients with recurrent GERD, particularly those with Barrett’s esophagus, for endoscopic surveillance," wrote Dr. Lofdahl of Karolinska Institutet, Stockholm, and his coauthors (Ann. Surg. 2013;257:579-82).

The case-control study drew its data from the Swedish Cancer Register. It comprised 295 patients who underwent antireflux surgery from 1996 to 2006. Fifty-five of the patients developed an adenocarcinoma of the esophagus sometime during the 7-year follow-up period.

Most of the patients in the study were male (87%). Smoking status did not differ significantly between the cases and controls (47% vs.42%, respectively). Recurrent reflux was significantly more common among the cases than among the controls (35% vs. 18%).

The multivariate analysis controlled for body mass index, smoking, and the type of antireflux surgery. In the final adjusted model, recurrent reflux conferred a threefold increase in the risk of a later esophageal adenocarcinoma. A BMI of more than 25 kg/m2 also increased the risk, but not significantly (odds ratio [OR] 1.6; confidence interval [CI]: 0.8-3.5). There were not enough patients with a BMI of greater than 30 kg/m2 to further tease out the effect of weight.

Having ever smoked tobacco also increased the risk of esophageal cancer, but again, the increase was not statistically significant (OR 1.4; CI: 0.7-2.8).

Compared with a partial fundoplication, a total 360-degree fundoplication was associated with a lower risk of cancer, but the difference was not statistically significant (OR 0.6; CI: 0.3-1.3).

"This finding might at least partly explain the lack of cancer-preventive effect of antireflux surgery," the investigators wrote.

The study was supported by the Swedish Research Council, the Swedish Cancer Society, and the Stockholm Cancer Society. None of the authors had financial disclosures.