Impact of endoscopic surveillance on mortality from Barrett's esophagus-associated esophageal adenocarcinomas.
Impact of endoscopic surveillance on mortality from Barrett's esophagus-associated esophageal adenocarcinomas.
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DOI：
10.1053/j.gastro.2013.05.004
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发表时间：
2013-08
期刊：
影响因子：
29.4
通讯作者：
Weiss NS
中科院分区：
文献类型：
--
作者：
Corley DA;Mehtani K;Quesenberry C;Zhao W;de Boer J;Weiss NS
尽管Barrett‘s食道患者通常接受内窥镜监测，但其在降低食道/胃食道交界部腺癌死亡率方面的有效性尚未得到严格评估。我们在以社区为基础的环境中进行了一项病例对照研究。在8272名Barrett‘s食道成员中，我们发现了351例食管腺癌：70例患者中有Barrett’s食道的先前诊断(符合监测条件)；51名患者死亡，38名患者死于癌症(病例)。将监测史与101名患有Barrett‘s食道的活体样本(对照组)进行对比，这些样本在年龄、性别和随访评估持续时间方面匹配。3年内接受调查与食管腺癌死亡风险的降低无关(调整后的优势比为0.99；95%可信区间为0.36-2.75)。死亡病例接受监测的可能性(55.3%)几乎与对照组(60.4%)一样高。Barrett‘s食道长度超过3厘米和既往发育不良均与随后的死亡率相关，但对这些因素的调整并没有改变主要发现。虽然所有患者都应该包括在疗效评估中，但排除了与癌症治疗相关的死亡和未能完成治疗的患者，改变了相关性的幅度，但没有改变相关性的意义(优势比，0.46；95%可信区间，0.13-1.64)。Barrett‘s食管病患者的内窥镜监测与食管腺癌死亡风险的显著降低无关。结果并不排除小到中等的好处。然而，如果存在这样的好处，我们的发现表明，它比目前估计的要小得多。监测的有效性在一定程度上受到现有治疗的可接受性和治疗相关死亡率的发生的影响。
Although patients with Barrett's esophagus commonly undergo endoscopic surveillance, its effectiveness in reducing mortality from esophageal/gastroesophageal junction adenocarcinomas has not been evaluated rigorously. We performed a case-control study in a community-based setting. Among 8272 members with Barrett's esophagus, we identified 351 esophageal adenocarcinoma: 70 in persons who had a prior diagnosis of Barrett's esophagus (who were eligible for surveillance); 51 of these patients died, 38 as a result of the cancers (cases). Surveillance histories were contrasted with a sample of 101 living persons with Barrett's esophagus (controls), matched for age, sex, and duration of follow-up evaluation. Surveillancei within 3 years was not associated with a decreased risk of death from esophageal adenocarcinoma (adjusted odds ratio, 0.99; 95% confidence interval, 0.36–2.75). Fatal cases were nearly as likely to have received surveillance (55.3%) as were controls (60.4%). A Barrett's esophagus length longer than 3 cm and prior dysplasia each were associated with subsequent mortality, but adjustment for these did not change the main findings. Although all patients should be included in evaluations of effectiveness, excluding deaths related to cancer treatment and patients who failed to complete treatment, changed the magnitude, but not the significance, of the association (odds ratio, 0.46; 95% confidence interval, 0.13–1.64). Endoscopic surveillance of patients with Barrett's esophagus was not associated with a substantially decreased risk of death from esophageal adenocarcinoma. The results do not exclude a small to moderate benefit. However, if such a benefit exists, our findings indicate that it is substantially smaller than currently estimated. The effectiveness of surveillance was influenced partially by the acceptability of existing treatments and the occurrence of treatment-associated mortality.
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DOI：
10.1164/rccm.200901-0076oc
发表时间：
2009-09-01
影响因子：
24.7
作者：
Infante, Maurizio;Cavuto, Silvio;Ravasi, Gianluigi
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影响因子：
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作者：
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影响因子：
168.9
作者：
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Cuzick, Jack
影响因子：
168.9
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Bobrow, Lynda