编者按：2024年9月22~24日，第20届世界食管疾病大会（ISDE）在苏格兰爱丁堡盛大召开。全球顶尖的医学专家与学术权威汇聚一堂，针对食管疾病领域的最新热点与前沿成果展开了深入交流与智慧碰撞。《肿瘤瞭望消化时讯》深入大会现场，对大会主席、北卡罗来纳大学教堂山分校Nicholas J. Shaheen教授进行了专访。现将访谈精华呈现，以飨读者。

肿瘤瞭望：您认为在GERD和食管癌领域面临哪些具体挑战？

Oncology Frontier:What specific challenges do you think we face in the field of GERD and esophageal cancer?

Prof. Nicholas J. Shaheen：As you know, GERD is a major risk factor for esophageal adenocarcinoma, and the link has been known for a long time.However, the mechanisms of this link, and whether or not we can make effective intervention early on that perhaps will force the stop of the development of cancer, is unclear.And I think one of the interesting things that is emerging now is that perhaps there is chemo prevention that can occur for these patients, either via, certain acid suppression, but perhaps other medications that may allow us to decrease the likelihood of development of cancer.In addition to that, I think that a main challenge that we face is understanding oncogenesis in squamous cell cancer and why it looks different in different parts of the world.And perhaps there is some preventative measures that we can take beyond cessation of alcohol or cigarette smoking that we've known about for a long time that may allow us to have early intervention or prevention in these states as well.

肿瘤瞭望：您近期对GERD及其与食管癌关系的研究提供了新的见解。这些发现对今年会议的议题和讨论有哪些影响？

Oncology Frontier:Your recent studies on GERD and its link to esophageal cancer have provided new insights. How have these findings shaped the topics and discussions at this year’s conference? Are there any particular studies or data you hope will drive significant advancements?

Prof. Nicholas J. Shaheen：It's becoming increasingly clear to us as we study GERD and esophageal adenocarcinoma, that we should really view these on a continuum of disease, going from mild GERD after eating a little too much all the way to severe GERD, which promotes metaplastic and finally dysplastic changes.The big issue that we face is that, at least in western societies, we're talking about 20% to 40% of the population having GERD, and obviously a very small proportion going on to neoplasia.There must be other genetic and environmental factors that promote the small subgroup going on to neoplasia.And some of the things that we're seeing at this conference this year have to do with stratifying risk, understanding genomic influences on risk, and seeing if perhaps by this combination of environmental and genetic exposures, we may be able to select that very small subgroup, that needle in the haystack, who would be eligible for early intervention to prevent late stage disease, which is how we usually diagnose these patients.

This conference traditionally has been focused on dealing with later stage disease. And despite our best efforts, both in squamous cell esophageal cancer as well as esophageal adenocarcinoma, outcomes are still poor.And since the majority of those patients are presenting latent disease, shifting that paradigm to try to find those T1 and T2 lesions that we can make an impactful difference is really where our focus is now.

肿瘤瞭望：考虑到您对先进内镜技术和食管癌的持续研究，您认为这些领域的下一个重大突破是什么？您计划如何将这些未来的进展融入您的工作和更广泛的领域？

Oncology Frontier:Considering your ongoing research into advanced endoscopic techniques and esophageal cancer, what do you see as the next big breakthrough in these areas? How do you plan to incorporate these future advancements into your work and into the broader field?

Nicholas J. Shaheen教授：当前，我们正集中力量将早期癌症的研究成果拓展至晚期癌症领域，以探索其适用性，并拓宽可能接受保器官治疗的患者范围。传统观念认为，仅非常表浅的食管癌适合内镜治疗。虽然在食管鳞状细胞癌中，一旦病情超出T1a期，仅依赖内镜干预的成功率便大幅降低。但令人振奋的是，内镜治疗在多模式治疗中的潜力逐渐显现，这一领域正变得极具吸引力。我强烈建议内镜医师积极参与肿瘤治疗团队的讨论。目前，我们已着手设计临床试验，将内镜治疗与系统化疗和/或放疗等其他多模式治疗相结合，以探索这种综合疗法是否能在清除病灶的同时保留器官。虽然目前仍处于初步阶段，但我相信这一领域的发展前景广阔，未来内镜治疗有望在晚期食管癌的多模式治疗中发挥关键作用。

Prof. Nicholas J. Shaheen：A big focus now is extending what we have learned about early cancers to see if we can apply those to cancers that are later on, expanding our field of patients that may be eligible for organ preserving intervention.Traditionally, we have thought that only very superficial esophageal cancers would be eligible for endoscopic therapy. And in truth, especially in squamous cell disease, once you get beyond T1a, the likelihood that an endoscopic intervention alone is going to be successful is relatively small.However, one really exciting and fascinating area is that perhaps endoscopic therapy deserves a role in consideration in multimodality therapy. And I am encouraging endoscopists to go to tumor board.And we are starting to see the construction of clinical trials now where we're combining endoscopic therapy with other multimodality therapies such as systemic chemotherapy and or radiation therapy, to see if the combination may be able to sterilize the field and still preserve the organ.These are early times, but I think it is exciting and I think there may be a time when endoscopic therapy has a role in multimodality therapy for later stage disease.