INTRODUCTION Achalasia is a postulated risk factor for esophageal cancer (EC); however, EC-associated risk in achalasia is understudied. We aimed to evaluate EC risk among individuals within the nationwide Veterans Affairs Achalasia Cohort (VA-AC). METHODS We conducted a matched cohort study among US Veterans ≥18 years from 1999-2019. Individuals with achalasia were age- and sex-matched 1:4 to individuals without achalasia. Follow-up continued from study entry until diagnosis with incident/fatal EC (primary outcome), death from non-EC related causes, or end of the study follow up (12/31/2019). Association between achalasia and EC risk was examined using Cox regression models. RESULTS We included 9,315 individuals in the analytic cohort (median age 55 years; 92% male): 1,863 with achalasia matched to 7,452 without achalasia. During median 5.5 years follow-up, 17 esophageal cancers occurred (3 esophageal adenocarcinoma (EAC), 12 squamous cell carcinoma (SCC), 2 unknown-type) among individuals with achalasia, compared to 15 esophageal cancers (11 EAC, 1 SCC, 3 unknown-type) among those without achalasia. EC incidence for those with achalasia was 1.4 per 1,000 person-years, and median time from achalasia diagnosis to EC development was 3.0 years (Q1-Q3: 1.3-9.1). Individuals with achalasia had higher cumulative EC incidence at 5, 10, and 15-years follow-up compared to individuals without achalasia, and EC risk was 5-fold higher (hazard ratio 4.6, 95% CI 2.3-9.2). DISCUSSION Based on substantial EC risk, individuals with achalasia may benefit from a high index of suspicion and endoscopic surveillance for EC.

中文翻译：

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贲门失弛缓症食管癌的风险：利用全国退伍军人事务贲门失弛缓症队列 (VA-AC) 进行的匹配队列研究。

引言 贲门失弛缓症是食管癌 (EC) 的假定危险因素；然而，贲门失弛缓症中与 EC 相关的风险尚未得到充分研究。我们的目的是评估全国退伍军人事务失弛缓症队列 (VA-AC) 中个体的 EC 风险。方法 我们在 1999 年至 2019 年期间对 18 岁以上的美国退伍军人进行了一项匹配队列研究。患有贲门失弛缓症的个体与没有贲门失弛缓症的个体年龄和性别匹配为1:4。随访从研究开始一直持续到诊断为事件/致命 EC（主要结果）、非 EC 相关原因死亡或研究随访结束（2019 年 12 月 31 日）。使用 Cox 回归模型检查贲门失弛缓症和 EC 风险之间的关联。结果 我们在分析队列中纳入了 9,315 名个体（中位年龄 55 岁；92% 为男性）：1,863 名患有贲门失弛缓症的患者与 7,452 名未患贲门失弛缓症的患者相匹配。在中位 5.5 年的随访期间，贲门失弛缓症患者发生了 17 例食管癌（3 例食管腺癌 (EAC)、12 例鳞状细胞癌 (SCC)、2 例未知型），而贲门失弛缓症患者则发生了 15 例食管癌（11 例 EAC、1 例 SCC、2 例食管癌）。 3 未知型）在无贲门失弛缓症的患者中。贲门失弛缓症患者的 EC 发病率为每 1,000 人年 1.4 例，从贲门失弛缓症诊断到发生 EC 的中位时间为 3.0 年（Q1-Q3：1.3-9.1）。与无贲门失弛缓症的个体相比，贲门失弛缓症患者在 5 年、10 年和 15 年随访时的累积 EC 发生率较高，且 EC 风险高出 5 倍（风险比 4.6，95% CI 2.3-9.2）。讨论 基于显着的 EC 风险，贲门失弛缓症患者可能受益于对 EC 的高度怀疑和内镜监测。