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| For decades, esophageal cancer has defied scientific attempts to discover a therapy that extends patients’ survival, year after year claiming the lives of such illustrious people as Humphrey Bogart, Christopher Hitchens and Ann Richards, the former governor of Texas. |
| 几十年来，尽管科学界努力开发延长患者存活时间的治疗方法，食道癌依然年复一年地夺走亨弗莱·鲍嘉(Humphrey Bogart)、克里斯托弗·希金斯(Christopher Hitchens)和前得克萨斯州长安·理查兹(Ann Richards)等杰出人士的生命。 |
| Now a large clinical trial offers hope, finding that a drug that unleashes the immune system to attack cancer cells can double the disease-free survival times in patients from 11 months to 22 months. The study was published on Wednesday in the New England Journal of Medicine. |
| 现在，一项大型临床试验带来了希望，研究发现一种能发动免疫系统攻击癌细胞的药物，可以将患者的无病生存时间从11个月提高到22个月。这项研究发表在周三的《新英格兰医学杂志》(New England Journal of Medicine)上。 |
| “It is a game changer,” said Dr. David Ilson, an esophageal cancer expert at Memorial Sloan Kettering Cancer Center in New York, who wrote an editorial accompanying the research. “We’ve waited a long time for this.” |
| “这能改变整个局面，”纽约的纪念斯隆·凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)食道癌专家戴维·伊尔森(David Ilson)博士说，他为这项研究撰写了一篇评论。“我们已经等了很久。” |
| In the trial, sponsored by Bristol-Myers Squibb, 794 patients in 29 countries were randomly assigned to receive infusions of the drug, nivolumab, or a placebo. |
| 在这项由百时美施贵宝(Bristol-Myers Squibb)赞助的试验中，来自29个国家的794名患者被随机分配接受注射这种名为纳武单抗(nivolumab)的药物或安慰剂。 |
| The patients had all had chemotherapy and radiation followed by surgery to remove their cancers. As usually happens, pathology reports showed that the surgery did not remove all of the cancer cells, which still lurked in lymph nodes and elsewhere, setting the stage in these patients for their cancers to return as incurable metastases. |
| 这些病人都接受了化疗和放疗，然后进行癌症切除手术。正如通常发生的情况一样，病理报告显示，手术并没有移除所有的癌细胞，它们仍然潜伏在淋巴结和其他地方，为这些患者的癌症出现无法治愈的转移复发创造了条件。 |
| Nivolumab is approved for some patients with other cancers, like Hodgkin’s lymphoma, melanoma and colorectal cancer. With the new study, experts expect the drug will readily win approval for treatment of early-stage esophageal cancer. |
| 纳武单抗已被批准用于其他癌症的一些患者，如霍奇金淋巴瘤、黑色素瘤和结肠直肠癌。有了这项新研究，专家们预计该药物将很容易获批用于治疗早期食道癌。 |
| Dr. Ronan Kelly, director of the Charles A. Sammons Cancer Center at Baylor University Medical Center and lead author of the new study, said he and the other researchers urgently wanted to help the 75 percent of patients who go through extraordinarily difficult sequences of radiation, chemotherapy and surgery that disfigures the digestive system, only to learn that cancer is still present or has a high likelihood of recurring. |
| 贝勒大学医学中心查尔斯·A·萨蒙斯癌症中心(Charles A. Sammons Cancer Center at Baylor University Medical Center)负责人、新研究的主要作者罗南·凯利(Ronan Kelly)博士说，他和其他研究人员迫切地想帮助75%的患者，他们经历了异常困难的放疗、化疗和破坏消化系统的手术，但却得知癌症仍然存在或很可能复发。 |
| Without some other form of treatment, “we knew many would recur quickly,” Dr. Kelly said. Additional chemotherapy not only was difficult for patients to tolerate, but it also did not seem to help. Nivolumab has few side effects and seemed worth a try. |
| 如果没有其他形式的治疗，“我们知道很多人会很快复发，”凯利说。额外的化疗不仅令患者难以忍受，而且似乎也没有帮助。纳武单抗的副作用很少，似乎值得一试。 |
| Esophageal cancer is rare in the United States, accounting for 1 percent of all cancers; about 15,000 patients die each year. But it is the seventh most common cancer globally, and frequently seen in East Asia, although it is not clear why, Dr. Ilson said. |
| 食道癌在美国很少见，占所有癌症的1%；每年大约有15000名患者死亡。但它是全球第七大最常见癌症，而且经常出现在东亚地区，尽管目前还不清楚原因，伊尔森说。 |
| Smoking is a risk factor, but researchers do not think the high smoking rates in China, for example, explain the high incidence. “We don’t think it’s environmental,” Dr. Ilson said. |
| 吸烟是一个危险因素，但研究人员认为，举例来说，中国的高吸烟率不能解释发病率高的原因。“我们不认为这是环境因素，”伊尔森说。 |
| Other risk factors include alcohol consumption and acid reflux disease. |
| 其他危险因素包括饮酒和胃酸反流疾病。 |
| Because the cancer is so rare in the United States, it has not gotten much research attention. While new treatments have revolutionized prospects for other cancer patients, those with esophageal cancer could only look on longingly. |
| 由于这种癌症在美国非常罕见，所以没有得到太多的研究关注。虽然新的治疗方法为其他癌症患者带来了革命性的前景，但食道癌患者只能望洋兴叹。 |
| That has weighed heavily on people with the disease, said Mindy Mordecai. Her husband, John, died of esophageal cancer in March 2008. She started an advocacy group called Esophageal Cancer Action Network. |
| 敏迪·莫迪凯(Mindy Mordecai)说，这令这种疾病的患者心情沉重。她的丈夫约翰于2008年3月死于食道癌。她创立了一个名为“食道癌行动网”(Esophageal Cancer Action Network)的倡导组织。 |
| “You can’t even imagine how demoralizing it is to see all the progress around you. ‘Please sir, may I have some more gruel?’” she said, quoting Oliver Twist, the Charles Dickens character in the eponymous novel, asking for a pittance. |
| “你甚至无法想象周围的进展有多么令人沮丧。‘先生，请问能再给点稀粥吗？’”她引用了查尔斯·狄更斯(Charles Dickens)同名小说中的奥利弗·特威斯特(Oliver Twist)乞讨微薄报酬时说的话。 |
| The new findings must be seen in the context of what patients go through when they develop esophageal cancer, experts said. Most learn they have the cancer after it has progressed to a point where they are unlikely to survive. |
| 专家说，这项新发现必须放在食道癌患者境遇的背景下来看待。大多数人是在癌症发展到不太可能存活的时候才知道自己得了癌症。 |
| But every patient hopes to be one of the lucky ones. “Our patients are always waiting for the other shoe to drop,” Ms. Mordecai said. “You have to understand what it’s like to live with that every day.” |
| 但是每个病人都希望自己是幸运的。“我们病人总是在等待另一只鞋掉下来，”莫迪凯说。“你必须了解每天带着这种情绪生活是什么感觉。” |
| The first step for most is chemotherapy and radiation. The treatment is so harsh that an oncology nurse told Mr. Mordecai it “brings Navy Seals to their knees,” Ms. Mordecai recalled. |
| 大多数人的第一步是化疗和放疗。莫迪凯回忆说，这种治疗太残酷了，一名肿瘤科护士对她的丈夫说，这种治疗“能让海豹突击队员都跪下”。 |
| The chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes it difficult to swallow. “Food won’t go down,” Ms. Mordecai said. “You just feel rotten.” |
| 化疗有很痛苦的副作用，放疗会引起灼烧感，使人难以吞咽。“食物吃不下去，”莫迪凯说。“你觉得非常难受。” |
| The next step is major surgery. A doctor takes out most of the patient’s esophagus, the tract leading from the mouth to the stomach, and then grabs the stomach and pulls it up, attaching it to a stump of esophagus left behind. |
| 下一步是大手术。医生取出病人的大部分食道，也就是从口腔通往胃部的通道，然后抓住胃部把它拉上来，连接到残余的食道上。 |
| The result is a stomach that is vertical, not horizontal, and lacks the sphincter muscle that normally keeps stomach acid from spilling out. For the rest of their lives, patients can never lie flat — if they do, the contents of their stomach, including acid, pours into their throats. They can choke, cough and aspirate. |
| 其结果就是一个垂直而不是水平的胃，而且缺乏正常情况下防止胃酸溢出的括约肌。在余生之中，病人永远不能平躺，否则胃部包括胃酸在内的东西就会涌进喉咙，令他们窒息、咳嗽和呕吐。 |
| Recovery is difficult, and morbidity and mortality are high. But most patients go through with the operation once they weigh their options. To refuse the treatment means giving up and letting the cancer close off the esophagus to the point where some cannot even swallow their own saliva, said Dr. Paul Helft, a professor of surgery and an ethicist at Indiana University School of Medicine. |
| 康复过程是困难的，复发率和死亡率也很高。但大多数患者在权衡种种选择后都会接受手术。印第安纳大学医学院(Indiana University School of Medicine)外科教授、伦理学家保罗·赫尔夫特(Paul Helft)博士说，拒绝治疗意味着放弃，任由癌症封闭食道，最后有些人甚至无法吞下自己的唾液。 |
| The treatment is so long and harrowing that Dr. Helft often uses it to teach medical students and other trainees about informed consent — about how patients must be fully informed before they start any given treatment. Esophageal cancer patients in particular must be told that they are likely to have a recurrence within the first year. |
| 治疗过程漫长而痛苦，赫尔夫特医生经常用它来教导医科学生和其他培训生关于知情同意的知识——病人在开始任何治疗前必须完全了解情况。特别是食管癌患者必须被告知他们很可能在一年内复发。 |
| Ms. Mordecai said her husband had his surgery at the end of September 2008. By Dec. 6, he had untreatable metastases in his liver. Now, she said, patients may have a glimmer of hope. |
| 莫迪凯说，她丈夫在2008年9月底做了手术。到12月6日，他的肝脏出现了无法治愈的转移。现在，她说，患者可能有了一线希望。 |
| Dr. Ilson, who has spent his career trying to develop therapies to help patients with esophageal cancer, said that he did not expect this treatment to succeed: “We all get nihilistic when faced with years of negative studies.” |
| 伊尔森的整个职业生涯都在开发帮助食道癌患者的疗法，他说，他本来并不指望这种疗法会成功：“面对多年结果为负面的研究，我们都变得虚无主义了。” |
| “This is really a landmark paper,” he added, and the drug “will become a new standard of care.” |
| “这确实是一篇具有里程碑意义的论文，”他还说，这种药物“将成为一种新的治疗标准”。 |
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