Comprehensive Analysis of Barrett's Esophagus: Focused on Carcinogenic Potential for Barrett's Cancer in Japanese Patients
Comprehensive Analysis of Barrett's Esophagus: Focused on Carcinogenic Potential for Barrett's Cancer in Japanese Patients
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DOI：
10.1007/s10620-020-06563-1
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发表时间：
2020-08-25
影响因子：
3.1
通讯作者：
Kato, Naoya
中科院分区：
文献类型：
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作者：
Ishikawa, Kentaro;Okimoto, Kenichiro;Kato, Naoya
背景/目的Barrett食管（BE）是食管腺癌（EAC）的前体病变。因此，准确诊断BE对于后续随访和早期发现EAC非常重要。然而，BE的定义尚未在世界范围内标准化;在大多数国家，没有肠上皮化生（IM）和/或< 1 cm的柱状内衬上皮（CLE）不被诊断为BE。本研究旨在阐明无IM和/或< 1 cm遗传性CLE的恶性潜能。方法对96例CLE患者（包括9例EAC）进行了检查。对CLE进行活检，并将患者分为IM和> 1 cm（A组）和无IM和/或< 1 cm（B组）。使用p53免疫化学染色评估恶性潜能。此外，使用下一代测序（NGS）对10例无幽门螺杆菌感染和无萎缩性胃炎的患者进行致病基因检测。结果B组66例。A组的癌/异型增生比例显著高于B组（26.7%和1.5%;P < 0.01）。然而，在B组中发现了1例EAC患者。在非EAC患者的免疫染色研究中，在A组中未观察到p53的异常表达，而在B组中的3名患者（4.6%）中观察到p53丢失。在NGS研究中，在组B中发现TP 53突变。结论不伴IM和/或<1cm的CLE具有恶性潜能。这一结果表明，CLE和BE患者需要随访。
Background/Aim Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma (EAC). Therefore, an accurate diagnosis of BE is important for the subsequent follow-up and early detection of EAC. However, the definitions of BE have not been standardized worldwide; columnar-lined epithelium (CLE) without intestinal metaplasia (IM) and/or < 1 cm is not diagnosed as BE in most countries. This study aimed to clarify the malignant potential of CLE without IM and/or < 1 cm genetically. Method A total of 96 consecutive patients (including nine patients with EAC) who had CLE were examined. Biopsies for CLE were conducted, and patients were divided into those with IM and > 1 cm (Group A) and those without IM and/or < 1 cm (Group B). Malignant potential was assessed using immunochemical staining for p53. Moreover, causative genes were examined using next-generation sequencing (NGS) on ten patients without Helicobacter pylori infection and without atrophic gastritis. Result Of the 96 patients, 66 were in Group B. The proportion of carcinoma/dysplasia in Group A was significantly higher than that in Group B (26.7% in Group A and 1.5% in Group B;p < 0.01). However, one EAC patient was found in Group B. In the immunostaining study for non-EAC patients, an abnormal expression of p53 was not observed in Group A, whereas p53 loss was observed in three patients (4.6%) in Group B. In the NGS study, a TP53 mutation was found in Group B. Conclusion CLE without IM and/or < 1 cm has malignant potential. This result suggests that patients with CLE as well as BE need follow-up.