Predictors of progression in Barrett's esophagus: current knowledge and future directions.
Predictors of progression in Barrett's esophagus: current knowledge and future directions.
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DOI：
10.1038/ajg.2010.2
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发表时间：
2010-07
影响因子：
9.8
通讯作者：
Wang, Kenneth K.
中科院分区：
文献类型：
--
作者：
Prasad, Ganapathy A.;Bansal, Ajay;Sharma, Prateek;Wang, Kenneth K.
巴雷特食管是食道腺癌（EAC）的高危人群，这是一种长期预后不佳的恶性肿瘤。EAC被认为是通过化生到不典型增生再到浸润性癌的进展而发展的。确定预测进展为EAC的因素将有助于对那些被认为有最高进展风险的患者进行集中监测、化学预防或消融。我们对文献进行了全面的回顾，并总结了已知BE患者进展的危险因素的现有证据。在一些研究中，临床和人口因素（年龄、男性、BE节段长度）与进展为EAC的几率略有增加有关。在单中心前瞻性队列研究中，非整倍体和p53杂合性缺失等生物标志物与进展为高度发育不良和/或EAC的风险增加有关。最近报道了一些有前途的新技术和标记物，它们有可能帮助对BE患者进行风险分层。开发包括临床和生物标志物变量的综合BE风险进展评分应该是最终目标，并且可以通过多中心前瞻性合作努力实现。虽然具有挑战性，但创建这样的评分有可能改善结果，并使BE患者的管理更具成本效益。
Barrett’s esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. EAC is thought to develop through progression of metaplasia to dysplasia to invasive carcinoma. Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. We performed a comprehensive review of the literature and summarized current evidence on risk factors for progression in subjects with known BE. Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. Promising newer techniques and markers have been recently reported with the potential to help risk stratify BE subjects. Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts. Though challenging, creation of such a score has the potential to improve outcomes and make the management of patients with BE more cost effective.
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