关键词：食管肿瘤预防和控制；增生平片；维胺酯；核黄素
【摘要】 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、切实可行的食管癌预防途径。
Long term effect of treatingpatients with precancerous lesions of the esophagus
DING Zhenwei, GAO Feng, LIN Peizhong, et al. Cancer Institute (Hospital), Chinese Academy of Medical Sciences, PekingUnion Medical College, Beijing 100021
【Abstract】 Objective Toreport long term therapeutic effect in patients with esophageal pre-cancerous lesions inhigh-risk area of esophageal cancer. Methods The therapeutic trialenrolled 2 531 cases of severe dysplasia and 3 393 cases of mild dysplasia. A 2-armrandomized, placebo-controlled design was used in which the participants received ZengSheng Ping (ZSP, an herbal composite), retinamide or placebo for cases with severedysplasia and riboflavin or placebo for those with mild dysplasia. Results Treatmentwith ZSP and retinamide decreased malignant transformation rate of severe dysplasia by52.2% and 43.2%, respectively after 5 years of treatment. When the treatment had beendiscontinued for 4 years, the rate of malignat transformation was decreased by 42.1% and38.2% respectively, which remained significantly higher than that of the placebo-treatedcontrol. 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 significantlydifferent from that of the placebo control. When the treatment was continued up to 9years, the rate was further decreased to 37.0%, which became statistically significant.Conclusion ZSP,retinamide and riboflavin treatment can effectively prevent esophageal dysplasia fromtransforming into carcinoma.
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