Association Between Length of Barrett's Esophagus and Risk of High-grade Dysplasia or Adenocarcinoma in Patients Without Dysplasia
Association Between Length of Barrett's Esophagus and Risk of High-grade Dysplasia or Adenocarcinoma in Patients Without Dysplasia
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DOI：
10.1016/j.cgh.2013.05.007
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发表时间：
2013-11-01
影响因子：
12.6
通讯作者：
Sharma, Prateek
中科院分区：
文献类型：
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作者：
Anaparthy, Rajeswari;Gaddam, Srinivas;Sharma, Prateek
背景与目的：Barrett‘s食道长度(BE)是否是高度异型增生(HGD)或食管腺癌(EAC)的危险因素，目前尚不清楚。我们研究了非发育不良BE患者进展到HGD或EAC的风险，基于节段长度。方法：我们分析了参加BE研究的大量患者的数据。BE研究是一个多中心结局项目，由5个美国三级护理转诊中心组成。组织学改变分级为低度异型增生、HGD或EAC。这项研究包括记录在案的BE长度但没有异型增生的患者和至少一年的随访评估(n=1175；88%为男性)，并排除在BE诊断后一年内发展为HGD或EAC的患者。平均随访期为5.5年(6463病人年)。HGD和EAC的年风险以3厘米为增量(=13厘米)绘制。结果：平均BE长度为3.6 cm，44例患者发生HGD或EAC，年发病率为0.67%，与未进展患者相比，发生HGD或EAC患者的BE节段较长(6.1vs3.5 cm；P<；.001)。Logistic回归分析显示BE长度每增加1厘米，发生HGD或EAC的风险增加28%(P=.01)。BE节段长度在3 cm或以下的患者发生HGD或EAC的时间长于BE节段长度大于4 cm的患者(6vs4y；P=无统计学意义)。结论：在BE无异型增生的患者中，BE的长度与HGD或EAC的进展有关。这一结果支持根据BE节段长度为这些患者制定风险分层方案。
BACKGROUND & AIMS: It is not clear whether length of Barrett's esophagus (BE) is a risk factor for high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with nondysplastic BE. We studied the risk of progression to HGD or EAC in patients with nondysplastic BE, based on segment length.METHODS: We analyzed data from a large cohort of patients participating in the BE Study-a multicenter outcomes project comprising 5 US tertiary care referral centers. Histologic changes were graded as low-grade dysplasia, HGD, or EAC. The study included patients with BE of documented length without dysplasia and at least 1 year of follow-up evaluation (n = 1175; 88% male), and excluded patients who developed HGD or EAC within 1 year of their BE diagnosis. The mean follow-up period was 5.5 y (6463 patient-years). The annual risk of HGD and EAC was plotted in 3-cm increments (= 13 cm). We calculated the association between time to progression and length of BE.RESULTS: The mean BE length was 3.6 cm; 44 patients developed HGD or EAC, with an annual incidence rate of 0.67%/y. Compared with nonprogressors, patients who developed HGD or EAC had longer BE segments (6.1 vs 3.5 cm; P < .001). Logistic regression analysis showed a 28% increase in risk of HGD or EAC for every 1-cm increase in BE length (P = .01). Patients with BE segment lengths of 3 cm or shorter took longer to develop HGD or EAC than those with lengths longer than 4 cm (6 vs 4 y; P = nonsignificant).CONCLUSIONS: In patients with BE without dysplasia, length of BE was associated with progression to HGD or EAC. The results support the development of a risk stratification scheme for these patients based on length of BE segment.