Risk of Malignant Progression in Barrett's Esophagus Patients: Results from a Large Population-Based Study
Risk of Malignant Progression in Barrett's Esophagus Patients: Results from a Large Population-Based Study
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DOI：
10.1093/jnci/djr203
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发表时间：
2011-07-01
期刊：
影响因子：
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通讯作者：
Murray, Liam J.
中科院分区：
文献类型：
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作者：
Bhat, Shivaram;Coleman, Helen G.;Murray, Liam J.
背景：Barrett食管（BE）是一种易发生食管腺癌的癌前病变。然而，BE患者中食管腺癌的报告发病率差异很大。我们使用来自北方爱尔兰巴雷特食管登记处（NIBR）的数据检查了BE患者恶性进展的风险，NIBR是全球最大的基于人群的BE登记处之一，包括1993年至2005年期间北方爱尔兰诊断为BE的每个成年人。定义为食管柱状上皮伴或不伴特化肠上皮化生（SIM），直到2008年底。通过将NIBR与北方爱尔兰癌症登记处进行匹配，确定食管或贲门偶发腺癌或食管高度异型增生的患者，并通过与注册总署的记录进行匹配确定死亡。癌症结局或高度异型增生的发生率计算为每100人-年（%/年）随访的事件，并使用考克斯比例风险模型确定年龄、性别、BE节段长度、SIM存在、肉眼BE或低度异型增生的发生率。结果经过平均7.0年的随访，79例患者被诊断为食管癌，16例贲门癌，36例高度异型增生。在整个队列中，食管癌或贲门癌或高度异型增生的合并发生率为每年0.22%（95%置信区间[CI] = 0.19%至0.26%）。46.0%的患者存在SIM。在SIM患者中，合并发生率为每年0.38%（95% CI = 0.31 - 0.46%）。在首次活检时有SIM的患者与无SIM的患者相比，癌症风险在统计学上显著升高（每年0.38% vs 0.07%;风险比[HR] = 3.54，95%CI = 2.09至6.00，P
Background Barrett's esophagus (BE) is a premalignant lesion that predisposes to esophageal adenocarcinoma. However, the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett's esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005.Subjects and Methods We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General's Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests.Results After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P