Lancet :吞下这颗小药丸,发现多达10倍癌前病变!创新检测或改变食管癌诊断

2020-08-04 药明康德内容团队 医学新视点

全球每年约50-60万例新发食管癌病例,且病死率高。其中,近半数食管癌病例在中国,食管癌也是中国主要癌症死亡原因之一。食管癌早期无特异性症状,多数患者确诊时已属晚期,治疗选择有限。

全球每年约50-60万例新发食管癌病例,且病死率高。其中,近半数食管癌病例在中国,食管癌也是中国主要癌症死亡原因之一。食管癌早期无特异性症状,多数患者确诊时已属晚期,治疗选择有限。即便在高收入国家,食管癌患者5年生存率也仅为25%左右。

不言而喻,早期诊断对于食管癌患者的生存至关重要。《柳叶刀》最新发表的研究中,一项创新检测技术带来了亮眼的结果:相较于常规内窥镜检查流程,一种可吞咽“小药丸”可以发现多达10倍的食管癌前病变患者,也能更好识别早期食管癌。

这项研究主要针对巴雷特食管(Barrett esophagus)这种癌前病变,这是胃食管反流病的并发症,也是食管腺癌的主要危险因素。随着胃食管反流病的增加,我国巴雷特食管和食管腺癌的发病率也在增加。

通常,巴雷特食管患者是在长期反流症状后,需要通过内窥镜检查而得到诊断。

剑桥大学研究团队开发的这种创新检测方法名为细胞海绵-三叶因子3(Cytosponge- TFF3),形似小药丸,患者吞咽后达到胃部会膨胀为小海绵,迅速拉出后,海绵收集到的食管细胞可以在实验室检测中利用标志物TFF3进行分析。

这项大型试验中,研究团队检测了这种创新检测方法与常规标准诊疗程序相比,能否检出更多巴雷特食管患者。

研究团队在英国109家全科诊所最终共纳入了13222名受试者,这些受试者已经接受胃食管反流治疗超过半年、且既往5年内未接受过内窥镜。受试者1:1随机分组,接受常规标准诊疗程序(仅在医生认为有必要时才接受内窥镜检查),或接受标准诊疗程序加上细胞海绵-TFF3检测,如TFF3检查为阳性,再进行内窥镜检查。

在一年的时间里,常规诊疗组仅检出13例巴雷特食管,而细胞海绵-TFF3检测组发现了140例,检出率是常规诊疗程序的10.6倍!此外,细胞海绵-TFF3还诊断出4例异型增生性巴雷特食管(瘤变级别更高)和5例早期食管癌,而在常规诊疗组中未发现此类病例。

在成功吞咽“小药丸”的患者中,最常见的副作用是喉咙痛,影响了约4%的患者。

研究通讯作者,剑桥大学Rebecca Fitzgerald教授表示:“经过近十年的研究,并对数千名患者进行测试,研究表明我们为诊断巴雷特食管提供了更好的方法。与内窥镜检查相比,细胞海绵可以让更多患者被早期发现并获得更好的生存机会,这是一种快速、简单且不适感很小的检测方法。”

英国癌症研究中心(Cancer Research UK)健康与患者信息负责人Julie Sharp博士指出:“这对患者来说是一个好消息,研究表明,这种检测方法是有益的,可以让不必要的患者免于可能不舒服的内窥镜检查;它也将极大地帮助医生够更准确地识别出具有食管癌风险的患者。”

值得一提的是,来自剑桥大学的退休科学家Liz Chipchase女士也是这项临床试验的受益者之一。她有多年的胃食管反流病史,不过近年来并无恶化,因此她自认为身体挺健康。不过,出于对新技术的兴趣,她欣然接受了临床试验的邀请。细胞海绵-TFF3检测结果发现,她不仅患有巴雷特食管,还患有早期食管癌。好在,她通过内窥镜手术切除了癌变组织,接受后续治疗后目前已经治愈。

“我知道食管癌的生存率并不高,能够治愈真是太好了。如果我没有被邀请参加试验,就不会知道我需要对早期癌症进行治疗。这次试验救了我的性命。”Liz Chipchase女士认为自己非常幸运。

目前,研究人员正在对这种测试进行经济方面的评估,希望在未来3-5年内能应用于临床实践,为胃食管反流患者提供癌症早筛服务。期待这种创新检测手段造福更多患者!

原始出处:

Rebecca C Fitzgerald, Massimiliano di Pietro, Maria O'Donovan, et al.Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial.Lancet. 2020 Aug 1;396(10247):333-344. doi: 10.1016/S0140-6736(20)31099-0.

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    2021-03-14 howi
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    2020-08-15 ms5000001168014345

    可是这个牵拉过程经过部分胃,口腔、咽喉不会造成影响吗

    0

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    2020-08-06 1def5843m65(暂无匿称)

    可不可以这样,我们吞下一块带牵引线的海棉块把他拉出来,取得海棉上所吸附的脱落细胞再做细胞学的检查这样不是就可以了吗❓

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1830769, encodeId=939f1830e6923, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Mar 14 19:56:04 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809122, encodeId=b8d5809122fc, content=可是这个牵拉过程经过部分胃,口腔、咽喉不会造成影响吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200724/ef0c4080eb2a4780a1c85b36dd003744/a39c7d8b2a4d4049bd58a460795d4b85.jpg, createdBy=5a4f5402647, createdName=ms5000001168014345, createdTime=Sat Aug 15 10:16:37 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806627, encodeId=4ea280662ecc, content=可不可以这样,我们吞下一块带牵引线的海棉块把他拉出来,取得海棉上所吸附的脱落细胞再做细胞学的检查这样不是就可以了吗❓, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ced1734358, createdName=1def5843m65(暂无匿称), createdTime=Thu Aug 06 20:06:20 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285892, encodeId=5a9d1285892ac, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437563, encodeId=bf25143e563c8, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806169, encodeId=342980616977, content=平常爱吃刚出炉的食物 很怕未来得食管癌 这个药丸值得期待......, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211106/ea1e44326e0946358e849b176cb8f385/463bdae7ebb241129b21a5680b639742.jpg, createdBy=329c5121051, createdName=liangying, createdTime=Tue Aug 04 19:32:00 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033913, encodeId=8dcb1033913df, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Aug 04 14:56:04 CST 2020, time=2020-08-04, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1830769, encodeId=939f1830e6923, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Mar 14 19:56:04 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809122, encodeId=b8d5809122fc, content=可是这个牵拉过程经过部分胃,口腔、咽喉不会造成影响吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200724/ef0c4080eb2a4780a1c85b36dd003744/a39c7d8b2a4d4049bd58a460795d4b85.jpg, createdBy=5a4f5402647, createdName=ms5000001168014345, createdTime=Sat Aug 15 10:16:37 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806627, encodeId=4ea280662ecc, content=可不可以这样,我们吞下一块带牵引线的海棉块把他拉出来,取得海棉上所吸附的脱落细胞再做细胞学的检查这样不是就可以了吗❓, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ced1734358, createdName=1def5843m65(暂无匿称), createdTime=Thu Aug 06 20:06:20 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285892, encodeId=5a9d1285892ac, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437563, encodeId=bf25143e563c8, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806169, encodeId=342980616977, content=平常爱吃刚出炉的食物 很怕未来得食管癌 这个药丸值得期待......, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211106/ea1e44326e0946358e849b176cb8f385/463bdae7ebb241129b21a5680b639742.jpg, createdBy=329c5121051, createdName=liangying, createdTime=Tue Aug 04 19:32:00 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033913, encodeId=8dcb1033913df, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Aug 04 14:56:04 CST 2020, time=2020-08-04, status=1, ipAttribution=)]
    2020-08-06 zhouqu_8
  6. [GetPortalCommentsPageByObjectIdResponse(id=1830769, encodeId=939f1830e6923, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Mar 14 19:56:04 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809122, encodeId=b8d5809122fc, content=可是这个牵拉过程经过部分胃,口腔、咽喉不会造成影响吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200724/ef0c4080eb2a4780a1c85b36dd003744/a39c7d8b2a4d4049bd58a460795d4b85.jpg, createdBy=5a4f5402647, createdName=ms5000001168014345, createdTime=Sat Aug 15 10:16:37 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806627, encodeId=4ea280662ecc, content=可不可以这样,我们吞下一块带牵引线的海棉块把他拉出来,取得海棉上所吸附的脱落细胞再做细胞学的检查这样不是就可以了吗❓, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ced1734358, createdName=1def5843m65(暂无匿称), createdTime=Thu Aug 06 20:06:20 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285892, encodeId=5a9d1285892ac, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437563, encodeId=bf25143e563c8, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806169, encodeId=342980616977, content=平常爱吃刚出炉的食物 很怕未来得食管癌 这个药丸值得期待......, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211106/ea1e44326e0946358e849b176cb8f385/463bdae7ebb241129b21a5680b639742.jpg, createdBy=329c5121051, createdName=liangying, createdTime=Tue Aug 04 19:32:00 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033913, encodeId=8dcb1033913df, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Aug 04 14:56:04 CST 2020, time=2020-08-04, status=1, ipAttribution=)]
    2020-08-04 liangying

    平常爱吃刚出炉的食物 很怕未来得食管癌 这个药丸值得期待......

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1830769, encodeId=939f1830e6923, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Mar 14 19:56:04 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809122, encodeId=b8d5809122fc, content=可是这个牵拉过程经过部分胃,口腔、咽喉不会造成影响吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200724/ef0c4080eb2a4780a1c85b36dd003744/a39c7d8b2a4d4049bd58a460795d4b85.jpg, createdBy=5a4f5402647, createdName=ms5000001168014345, createdTime=Sat Aug 15 10:16:37 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806627, encodeId=4ea280662ecc, content=可不可以这样,我们吞下一块带牵引线的海棉块把他拉出来,取得海棉上所吸附的脱落细胞再做细胞学的检查这样不是就可以了吗❓, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7ced1734358, createdName=1def5843m65(暂无匿称), createdTime=Thu Aug 06 20:06:20 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1285892, encodeId=5a9d1285892ac, content=<a href='/topic/show?id=77903209422' target=_blank style='color:#2F92EE;'>#创新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32094, encryptionId=77903209422, topicName=创新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=512a199, createdName=lilianxiang, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437563, encodeId=bf25143e563c8, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Aug 06 02:56:04 CST 2020, time=2020-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806169, encodeId=342980616977, content=平常爱吃刚出炉的食物 很怕未来得食管癌 这个药丸值得期待......, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211106/ea1e44326e0946358e849b176cb8f385/463bdae7ebb241129b21a5680b639742.jpg, createdBy=329c5121051, createdName=liangying, createdTime=Tue Aug 04 19:32:00 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033913, encodeId=8dcb1033913df, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Aug 04 14:56:04 CST 2020, time=2020-08-04, status=1, ipAttribution=)]
    2020-08-04 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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