食道鳞状细胞癌（ESCC）的发病率高，预后差。酒精饮用、吸烟和槟榔嘴嚼被广为认识的危险因素。菌群不平衡（Dysbiosis）是人类疾病，尤其是癌症的相关因素。本文回顾了ESCC癌变中食道菌群的现有证据，包括癌变的启动、进展和耐药性。近10年，在PubMed进行广泛的文献搜索，涉及食道菌群、诊断、治疗和食道癌进展的文章。基于16S rRNA测序的人类样本、细胞和动物实验研究，当前证据表明食道菌群不平衡促进ESCC进展和化疗耐药，导致预后不佳。吸烟和饮酒与食道菌群不平衡相关。一些特定细菌，如牙龈卟啉菌（Porphyromonas gingivalis）和根瘤班杆菌（Fusobacterium nucleatum）已被报道可以促进ESCC的癌症发生，包括进展或耐药性。这些细菌通过TLR4/NF-κB和IL-6/STAT3途径促进ESCC细胞增殖和迁移。F. nucleatum通过免疫抑制性骨髓来源抑制细胞的富集（MDSCs）引起顺铂耐药。纠正菌群不平衡，降低食道病原菌的丰度，可能有助于抑制癌症进展。综上所述，食道菌群不平衡与ESCC进展和化疗耐药性有关。筛查口腔和食道菌群是预测ESCC发展或耐药性的潜在诊断工具。修复食道菌群不平衡是ESCC的新型治疗方法。有必要开展使用益生菌辅助目前化疗的临床试验，以研究其治疗效果。版权所有，2023年发表于《胸部癌症》（Thoracic Cancer），由中国肺癌学组和约翰威利和澳大利亚有限公司出版。

Esophageal squamous cell carcinoma (ESCC) exhibits high incidence with poor prognosis. Alcohol drinking, cigarette smoking, and betel nut chewing are well-known risk factors. Dysbiosis, an imbalance of the microbiota residing in a local environment, is known to be associated with human diseases, especially cancer. This article reviews the current evidence of esophageal microbiota in ESCC carcinogenesis, including initiation, progression, and drug resistance. Articles involving the esophageal microbiota, diagnosis, treatment, and the progression of esophageal cancer were acquired using a comprehensive literature search in PubMed in recent 10 years. Based on 16S rRNA sequencing of human samples, cell, and animal studies, current evidence suggests dysbiosis of the esophagus promotes ESCC progression and chemotherapy resistance, leading to a poor prognosis. Smoking and drinking are associated with esophageal dysbiosis. Specific bacteria have been reported to promote carcinogenesis, involving either progression or drug resistance in ESCC, for example Porphyromonas gingivalis and Fusobacterium nucleatum. These bacteria promote ESCC cell proliferation and migration via the TLR4/NF-κB and IL-6/STAT3 pathways. F. nucleatum induces cisplatin resistance via the enrichment of immunosuppressive myeloid-derived suppressor cells (MDSCs). Correcting the dysbiosis and reducing the abundance of specific esophageal pathogens may help in suppressing cancer progression. In conclusion, esophageal dysbiosis is associated with ESCC progression and chemoresistance. Screening the oral and esophageal microbiota is a potential diagnostic tool for predicting ESCC development or drug-resistance. Repairing esophageal dysbiosis is a novel treatment for ESCC. Clinical trials with probiotics in addition to current chemotherapy are warranted to study the therapeutic effects.© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.