Understanding the malignant potential of gastric metaplasia of the oesophagus and its relevance to Barrett's oesophagus surveillance: individual-level data analysis
Understanding the malignant potential of gastric metaplasia of the oesophagus and its relevance to Barrett's oesophagus surveillance: individual-level data analysis
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DOI：
10.1136/gutjnl-2023-330721
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发表时间：
2023-11-21
期刊：
影响因子：
24.5
通讯作者：
Fitzgerald，Rebecca C.
中科院分区：
文献类型：
--
作者：
Black，Emily L.;Ococks，Emma;Fitzgerald，Rebecca C.
食管胃上皮化生（gastric metaplasia，GM）是否应被认为是Barrett食管（Barrett's oesophagus，BO）尚有争议。考虑到肠上皮化生（IM）可能由于采样而被遗漏，英国指南将GM作为BO的一种类型。在这里，我们调查是否误诊的风险和恶性潜力的GM保证其在英国surveillance.DesignWe进行了彻底的病理和内窥镜检查审查，以遵循临床结果在一个新的英国队列244例患者，涵盖1854人年的后续行动。我们补充了160 GM和IM标本的比较基因组分析，专注于BO和食管腺癌（OAC）的早期分子标志，我们发现，77个短段（<3 cm）GM（SS-GM）的情况下，58（75%）继续观察GM-只有在中位数为4.4年的随访。我们观察到，仅GM病例和GM+IM病例（在某些情况下报告GM，在其他情况下报告IM）的疾病进展显著低于仅IM病例（Kaplan-Meier，p=0.03）。基因组学分析显示GM中的突变负荷显著低于IM（p<0.01）。此外，转基因不具有OAC的突变特征，缺乏相关的签名和驱动基因突变。最后，我们建立了GM发现相邻OAC是进化远离cancer.ConclusionSS-GM是一个不同的实体从SS-IM和GM的恶性潜力低于IM。是否有理由将SS-GM纳入BO监测值得怀疑。
ObjectiveWhether gastric metaplasia (GM) of the oesophagus should be considered as Barrett’s oesophagus (BO) is controversial. Given concern intestinal metaplasia (IM) may be missed due to sampling, the UK guidelines include GM as a type of BO. Here, we investigated whether the risk of misdiagnosis and the malignant potential of GM warrant its place in the UK surveillance.DesignWe performed a thorough pathology and endoscopy review to follow clinical outcomes in a novel UK cohort of 244 patients, covering 1854 person years of follow-up. We complemented this with a comparative genomic analysis of 160 GM and IM specimens, focused on early molecular hallmarks of BO and oesophageal adenocarcinoma (OAC).ResultsWe found that 58 of 77 short-segment (<3 cm) GM (SS-GM) cases (75%) continued to be observed as GM-only across a median of 4.4 years of follow-up. We observed that disease progression in GM-only cases and GM+IM cases (cases with reported GM on some occasions, IM on others) was significantly lower than in the IM-only cases (Kaplan-Meier, p=0.03). Genomic analysis revealed that the mutation burden in GM is significantly lower than in IM (p<0.01). Moreover, GM does not bear the mutational hallmarks of OAC, with an absence of associated signatures and driver gene mutations. Finally, we established that GM found adjacent to OAC is evolutionarily distant from cancer.ConclusionSS-GM is a distinct entity from SS-IM and the malignant potential of GM is lower than IM. It is questionable whether SS-GM warrants inclusion in BO surveillance.