2010-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657835摘要：食道癌是全球常見癌症死因中的第六位，是重要的公共衛生課題。在台灣，食道癌發生率與死亡率都在逐年上升中，相反地，在其他開發中區域，隨著環境衛生改善其發生率卻是逐步下降，這種矛盾之狀況值得我們注意。以組織病理學而言，鱗狀上皮細胞癌佔台灣食道癌百分之九十以上，此種食道癌與抽菸、喝酒、嚼檳榔，以及頭頸部癌症息息相關。這種區域性癌化現象 (或稱癌域理論)，使得這類癌症病人儘管接受多方治療，包括手術、放射線治療、以及化學治療，其存活率仍無法並無法顯著提升，因此，針對食道鱗狀上皮細胞癌之預防醫學發展十分重要。就食道癌預防醫學角度來看，要完全避免危險因子的暴露在執行面上仍然困難，目前臨床較常用的預防方式為標示出處於高風險的族群病人，並轉介這些病人去接受確診工具以及早期接受治癒性之治療，也就是次段預防醫學的領域。近年來內視鏡科技大幅進步，包括了許多種類之內視鏡強化對比影像系統，可提升小型病灶或是癌前病變的偵測率，並且得以預測其侵襲之深度，以利於後續之治療選擇。此外，針對病人非罹癌處之正常食道黏膜組織做基因以及基因外變化之檢測，用以預測病人日後食道癌發生風險之研究，近年來正蓬勃發展，在罹癌風險評估上十分重要。在本研究計畫中，我們將驗證先進內視鏡科技之臨床效用，並評估常見風險因子暴露之影響，以期訂定食道癌風險評估方式。此外，我們亦希望能釐清食道組織在癌化前DNA的改變，有利於早期診斷早期治療，避免不可逆病變之發生。本研究計畫之最重要目標，乃是期望將基因或是基因外於癌前組織之變化，轉譯成臨床上可用的資訊，實現量身訂做之篩檢策略，高風險之個人可進一步接受高偵測率之內視鏡篩檢，以期降低食道麟狀上皮癌對於國人健康之影響。我們的研究族群大多為具嚼檳榔習慣之台灣民眾，有創見並具臨床價值的研究結果是可以預期的。<br> Abstract: Esophageal cancer is ranking as the sixth most common cause of cancer death worldwide and affects public health substantially. In Taiwan, the incidence and mortality rates of esophageal cancer raise rapidly, which is in contrast with what has happened in developing regions where the improvement of socioeconomic conditions is lowering the incidence of this cancer. Squamous cell carcinoma constitutes more than 90% of esophageal cancers in Taiwan, which is related to the prevalent use of smoking, alcohol, and betel nut chewing and is closely linked with the development of head and neck cancers. Such a phenomenon of field carcinogenesis has suppressed the survival rate of patients with this carcinoma despite a multidisciplinary approach that includes surgery, radiotherapy, and chemotherapy alone or in combination. These findings suggest preventive strategies are of paramount importance. Since primary elimination of risk factor exposure remains an obstacle, the current rationale of esophageal cancer prevention is to identify high-risk group at first stage and further refer them to receive confirmatory diagnosis and early treatment, namely secondary prevention. Recent advances in endoscopic technology, including the imaging enhanced endoscopy and magnification has improved our ability to identify the margin of small cancer foci and to predict their invasiveness. Calibration of genetic and epigenetic information derived from non-cancerous esophageal mucosa is under extensive investigation, which may realize risk assessment and enable individual tailored preventive strategies. In the present proposal, we aimed to validate the modern endoscopic technology, to formulate risk score based on common risk factors, and to elucidate the molecular changes before the development of irreversible damage. Our major interest is to translate the genetic/epigenetic alterations in the esophageal mucosa into the clinically useful information in order to decrease the disease burden in our country. Our target population is characterized with the prevalent usage of betel nut and certainly, unique and novel findings will be expected.