Esophageal cancer, primarily comprising the squamous cell carcinoma (ESCC) and adenocarcinoma (EAC) subtypes, is the sixth leading cause of cancer deaths globally. In addition to many well-established endogenous and exogenous risk factors, there is emerging evidence for the etiologic role of infectious agents in esophageal cancer, although these associations are incompletely understood. Here, we review the currently available literature on the relationship between infectious agents and esophageal cancer. By far, human papilloma virus (HPV), particularly HPV 16 and 18, have the strongest etiologic association with ESCC. Less robust is the association of high-risk HPV (hr-HPV) with EAC. AlthoughH. pylorihas been implicated in the development of EAC via increased acid reflux, decreased lower esophageal sphincter tone, and the resultant Barrett’s metaplasia–dysplasia–adenocarcinoma pathway, some hypothesize based on epidemiological trends thatH. pylorimay in fact be a protective factor. In rare cases, EBV can cause esophageal lymphoepithelial carcinoma. Several other agents including HSV, polyomaviruses, and Candida are associated with esophageal cancer to varying degrees. In summary, while several studies, including those conflicting with each other, implicate several infectious agents, the evidence is weak, at best. Clearly, further work is needed to help solidify clear etiologies that will help facilitate prevention and treatment.
食管癌是全球癌症死亡的第六大原因，主要包括鳞状细胞癌（ESCC）和腺癌（EAC）两种亚型。除了许多已明确的内源性和外源性风险因素外，越来越多的证据表明感染因子在食管癌的病因学中扮演着角色，尽管这些关联尚未完全明确。本文综述了目前关于感染因子与食管癌关系的现有文献。迄今为止，人乳头瘤病毒（HPV），特别是HPV 16和18型，与ESCC的病因学关联最为明确。高危型HPV（hr-HPV）与EAC的关联则相对较弱。尽管幽门螺杆菌被认为通过增加胃酸反流、降低食管下括约肌张力，并由此引发巴雷特食管化生-异型增生-腺癌途径，从而参与EAC的发生，但一些基于流行病学趋势的假设认为，幽门螺杆菌实际上可能是一种保护性因素。在罕见情况下，EB病毒可导致食管淋巴上皮癌。包括单纯疱疹病毒、多瘤病毒和念珠菌在内的其他几种病原体也与食管癌存在不同程度的关联。总之，尽管多项研究（包括相互矛盾的研究）暗示了多种感染因子的作用，但证据最多只能说是薄弱的。显然，需要进一步的研究来帮助明确病因，以促进预防和治疗。
Infectious Agents and Esophageal Cancer: A Comprehensive Review
肿瘤(癌症)患者之家