Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus.
Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus.
复制标题
DOI：
10.1016/j.gie.2009.08.031
复制
发表时间：
2010-04
影响因子：
7.7
通讯作者：
Borkenhagen, Lynn S.
中科院分区：
文献类型：
--
作者：
Badreddine, Rami J.;Prasad, Ganapathy A.;Wang, Kenneth K.;Song, Louis M. Wong Kee;Buttar, Navtej S.;Dunagan, Kelly T.;Lutzke, Lori S.;Borkenhagen, Lynn S.
Barrett食管（BE）消融后异型增生复发的发生率和风险因素尚未明确。确定BE患者光动力治疗（PDT）后异型增生/肿瘤复发的发生率和预测因素。在专门BE单位就诊的BE患者前瞻性队列的回顾性分析。消融术后每隔3个月对患者进行一次标准方案评估，包括食管胃镜检查和每厘米4象限活检。复发定义为连续2次内镜检查后出现任何级别的异型增生或瘤变，无异型增生。评估了入组组织学、人口统计学、BE长度、疝的存在和长度、EMR、狭窄形成、非甾体抗炎药使用、吸烟和非异型增生BE或鳞状上皮的存在的单变量相关性。采用考克斯比例风险回归分析复发时间。构建多变量模型以建立与复发的独立关联。共有363例患者接受了PDT伴或不伴EMR。其中，261例患者纳入最终分析（44例失访，46例有残留异型增生，12例基线时无异型增生）。消融适应症为低度异型增生（53例患者，20%）、高度异型增生（152例患者，58%）和粘膜内癌（56例患者，21%）。中位随访时间为36个月（四分位距18-79个月）。复发45例。中位复发时间为17个月（四分位距8-45个月）。多变量模型中复发的重要预测因素是年龄较大（风险比[HR] 1.04，P= 0.029），存在残留的非异型增生BE（HR 2.88，P= 0.012）和吸烟史（HR 2.68，P= 0.048）。尽管进行了积极的监测，但仍有可能遗漏普遍的异型增生。PDT消融后发育异常/瘤形成的复发与高龄、吸烟和BE残留有关。
The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined. To determine the rate and predictors of dysplasia/neoplasia recurrence after photodynamic therapy (PDT) in BE. Retrospective analysis of a prospective cohort of BE patients seen at a specialized BE unit. Patients underwent a standard protocol assessment with esophagogastroduodenoscopy and 4-quadrant biopsies every centimeter at 3-month intervals after ablation. Recurrence was defined as the appearance of any grade of dysplasia or neoplasia after 2 consecutive endoscopies without dysplasia. Entry histology, demographics, length of BE, presence and length of diaphragmatic hernia, EMR, stricture formation, nonsteroidal anti-inflammatory drug use, smoking, and the presence of nondysplastic BE or squamous epithelium were assessed for univariate associations. Time-to-recurrence analysis was done by using Cox proportional hazards regression. A multivariate model was constructed to establish independent associations with recurrence. A total of 363 patients underwent PDT with or without EMR. Of these, 261 patients were included in the final analysis (44 lost to follow-up, 46 had residual dysplasia, and 12 had no dysplasia at baseline). Indication for ablation was low-grade dysplasia (53 patients, 20%), high-grade dysplasia (152 patients, 58%), and intramucosal cancer (56 patients, 21%). Median follow-up was 36 months (interquartile range 18-79 months). Recurrence occurred in 45 patients. Median time to recurrence was 17 months (interquartile range 8-45 months). Significant predictors of recurrence on the multivariate model were older age (hazard ratio [HR] 1.04, P=.029), presence of residual nondysplastic BE (HR 2.88, P=.012), and a history of smoking (HR 2.68, P=.048). Possibility of missing prevalent dysplasia despite aggressive surveillance. Recurrence of dysplasia/neoplasia after PDT ablation is associated with advanced age, smoking, and residual BE.
登录
查看更多内容
影响因子：
29.4
作者：
Bronner, Mary P.;Overholt, Bergen F.;Depot, Michelle
通讯作者：
Depot, Michelle
影响因子：
7.7
作者：
Peters, FR;Kara, MA;Bergman, JJGHM
通讯作者：
Bergman, JJGHM
影响因子：
9.8
作者：
Hornick, Jason L.;Mino-Kenudson, Mari;Odze, Robert D.
通讯作者：
Odze, Robert D.
影响因子：
7.7
作者：
Overholt, BF;Lightdale, CJ;Depot, M
通讯作者：
Depot, M
影响因子：
4.3
作者：
Anderson, Lesley A.;Watson, R. G. Peter;Murray, Liam J.
通讯作者：
Murray, Liam J.