Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study
Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study
复制标题
DOI：
10.1136/gut.2009.176701
复制
发表时间：
2010-08-01
期刊：
影响因子：
24.5
通讯作者：
Kuipers, Ernst J.
中科院分区：
文献类型：
--
作者：
de Jonge, Pieter J. F.;van Blankenstein, Mark;Kuipers, Ernst J.
研究背景巴雷特食道(BO)中食管腺癌(OAC)的发病率差异很大。由于BO监测的有效性关键依赖于这一比率，因此其澄清是至关重要的。方法为了估计BO患者的恶性进展率，在荷兰全国组织病理学登记(PALGA)中确定了1991至2006年间所有首次诊断为无异型增生(ND)或低级别异型增生(LGD)的BO患者。结果共纳入BO患者42 207例，其中LGD患者4132例(8%)。初诊后至少6个月再次接受内窥镜检查的患者有16365例(39%)，他们显著低于未复查的患者(58+/-13vs63+/-16岁，p75岁HR 12；95%CI 8.0-18)，男性(2.01；1.68-2.60)和基线时存在LGD(1.91；1.53-2.40)。男性、高龄和确诊时的LGD是恶性进展的独立预测因素，应该能够改善BO的风险评估。
Background Reported incidence rates of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus (BO) vary widely. As the effectiveness of BO surveillance is crucially dependent on this rate, its clarification is essential.Methods To estimate the rate of malignant progression in patients with BO, all patients with a first diagnosis of BO with no dysplasia (ND) or low-grade dysplasia (LGD) between 1991 and 2006 were identified in the Dutch nationwide registry of histopathology (PALGA). Follow-up data were evaluated up to November 2007.Results 42 207 patients with BO were included; 4132 (8%) of them had LGD. Re-evaluation endoscopies at least 6 months after initial diagnosis were performed in 16 365 patients (39%), who were significantly younger than those not re-examined (58 +/- 13 vs 63 +/- 16 years, p75 years HR 12; 95% CI 8.0 to 18), male sex (2.01; 1.68 to 2.60) and presence of LGD at baseline (1.91; 1.53 to 2.40).Conclusion In this largest reported cohort of unselected patients with BO, the annual risk of OAC was 0.4%. Male sex, older age and LGD at diagnosis are independent predictors of malignant progression, and should enable an improved risk assessment in BO.