Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett's oesophagus
Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett's oesophagus
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DOI：
10.1136/gutjnl-2014-308865
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发表时间：
2016-08-01
期刊：
影响因子：
24.5
通讯作者：
Kramer, Jennifer R.
中科院分区：
文献类型：
--
作者：
El-Serag, Hashem B.;Naik, Aanand D.;Kramer, Jennifer R.
背景Barrett食管（BE）患者的监测内镜检查对降低BE患者食管腺癌（EAC）相关死亡率的有效性尚不清楚，这是一项队列研究，研究对象为2004-2009年期间在国家退伍军人事务部医院诊断为BE的患者，不包括那些影响总生存率的患者。我们确定了2011年BE诊断后诊断为EAC的患者，并进行了图表审查，以确定BE监测计划和EAC诊断的适应症，验证诊断、分期、治疗和死亡原因。我们研究了EAC诊断与或不监测程序和EAC阶段和治疗接收的Logistic回归模型的监测指标之间的关联，并与死亡或癌症相关死亡的时间使用考克斯比例风险回归model.Results在29 536例BE，424例患者发展EAC在平均随访5.0年。共有209例（49.3%）EAC患者在BE监测计划中，并通过监测内镜检查确诊。这些患者更可能在早期被诊断（0期或1期：74.7% vs 56.2%，p
Background The effectiveness of surveillance endoscopy in patients with Barrett's oesophagus (BE) for reducing oesophageal adenocarcinoma (EAC)-related mortality in patients with BE is unclear.Methods This is a cohort study of patients with BE diagnosed in the National Veterans Affairs hospitals during 2004-2009 excluding those with conditions that affect overall survival. We identified those diagnosed with EAC after BE diagnosis through 2011 and conducted chart reviews to identify BE surveillance programme, and indication for EAC diagnosis, verify diagnosis, stage, therapy and cause of death. We examined the association between surveillance indication for EAC diagnosis with or without surveillance programme and EAC stage and treatment receipt in logistic regression models, and with time to death or cancer-related death using a Cox proportional hazards regression model.Results Among 29 536 patients with BE, 424 patients developed EAC during a mean follow-up of 5.0 years. A total of 209 (49.3%) patients with EAC were in BE surveillance programme and were diagnosed as a result of surveillance endoscopy. These patients were more likely to be diagnosed at an early stage (stage 0 or 1: 74.7% vs 56.2, p