文章：

我将与之抗争的疾病：食管胃癌五千年历史及其治疗综述，特别聚焦免疫治疗新进展

An Ailment with Which I Will Contend: A Narrative Review of 5000 Years of Esophagogastric Cancers and Their Treatments, with Special Emphasis on Recent Advances in Immunotherapeutics

原文发布日期：31 January 2024

DOI: 10.3390/cancers16030618

类型: Article

开放获取: 是

英文摘要：

Esophagogastric cancers are among the most common and deadly cancers worldwide. This review traces their chronology from 3000 BCE to the present. The first several thousand years were devoted to palliation, before advances in operative technique and technology led to the first curative surgery in 1913. Systemic therapies were introduced in 1910, and radiotherapy shortly thereafter. Operative technique improved massively over the 20th century, with operative mortality rates reducing from over 50% in 1933 to less than 5% by 1981. In addition to important roles in palliation, endoscopy became a key nonsurgical curative option for patients with limited-stage disease by the 1990s. The first nonrandomized studies on combination therapies (chemotherapy ± radiation ± surgery) were reported in the early 1980s, with survival benefit only for subsets of patients. Randomized trials over the next decades had similar overall results, with increasing nuance. Disparate conclusions led to regional variation in global practice. Starting with the first FDA approval in 2017, multiple immunotherapies now encompass more indications and earlier lines of therapy. As standards of care incorporate these effective yet expensive therapies, care must be given to disparities and methods for increasing access.

摘要翻译： 

食管胃部癌症是全球范围内最常见且致死率最高的癌症之一。本文综述了从公元前3000年至今该疾病诊疗技术的发展历程。在长达数千年的初期阶段，治疗主要集中于缓解症状，直至手术技术与医疗设备的进步促成了1913年首例根治性手术的实施。系统性药物治疗于1910年引入临床，放射治疗随后不久得以应用。整个20世纪手术技术取得巨大突破，手术死亡率从1933年的超过50%降至1981年的不足5%。除在姑息治疗中发挥重要作用外，到1990年代内镜技术已成为早期局限性病变患者的关键非手术根治方案。关于联合疗法（化疗±放疗±手术）的首批非随机研究于1980年代初发表，但仅对部分患者群体显示出生存获益。随后数十年的随机试验虽在整体结果上相似，但治疗分层日益精细。不同研究结论的差异导致了全球临床实践的地域性分歧。自2017年获得美国食品药品监督管理局首次批准以来，多种免疫疗法现已覆盖更广泛的适应症并应用于更早期的治疗阶段。随着这些高效但昂贵的疗法被纳入标准治疗方案，必须重点关注医疗可及性差异问题并探索提升治疗普及率的有效途径。

原文链接：

An Ailment with Which I Will Contend: A Narrative Review of 5000 Years of Esophagogastric Cancers and Their Treatments, with Special Emphasis on Recent Advances in Immunotherapeutics