Oesophageal cancer incidence and mortality in patients with long-segment Barrett's oesophagus after a mean follow-up of 12.7 years
Oesophageal cancer incidence and mortality in patients with long-segment Barrett's oesophagus after a mean follow-up of 12.7 years
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DOI：
10.1080/00365520410003524
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发表时间：
2004-12-01
影响因子：
1.9
通讯作者：
Kuipers, EJ
中科院分区：
文献类型：
--
作者：
Hage, M;Siersema, PD;Kuipers, EJ
背景资料：来自较早研究的长节段Barrett食管（BO）患者的癌症风险数据通常难以解释，因为BO的定义已从内镜诊断演变为组织学诊断。在这项工作中，根据现行标准重新定义了鹿特丹BO队列的诊断，以获得未接受标准内镜监测的患者的癌症风险的更准确数据。此外，还确定了首次内镜检查时存在的哪些患者因素与BO中的肿瘤进展相关。方法：鹿特丹BO队列包括1973年至1984年间内镜诊断的所有BO大于或等于3 cm的患者。在本研究中，仅纳入肠上皮化生患者（n = 105）。通过问卷调查和/或与患者或治疗医生的访谈获得随访数据。Kaplan-Meier分析用于估计20年风险。结果：BO长度3 ~ 15 cm，平均7.1cm。在1329患者年随访期间，6/105（6%）例患者发生BO癌症，5/105（5%）例患者发生高度异型增生（HGD），相当于每221患者年发生1例癌症病例，每266患者年发生1例HGD病例。在平均随访12.7年后，72例（69%）患者死亡;其中只有4例死于食管癌或其治疗。BO的长度越长，进展为HGD或癌症的风险越高（P < 0.02）。24例曾有低度异型增生的患者中有6例在诊断为BO后2 - 16年进展为HGD或癌症。结论：长节段BO患者发生HGD或腺癌的年风险为0.83%。然而，即使在长节段BO患者队列中，腺癌导致的死亡也不常见。
Background: Data on cancer risk in patients with long-segment Barrett's oesophagus (BO) from older studies are often difficult to interpret, since the definition of BO has evolved from an endoscopical to a histological diagnosis. In this work the diagnoses in the Rotterdam BO cohort on current standards was redefined to obtain more accurate data on cancer risk in patients who had not undergone standard endoscopic surveillance. In addition, it was determined which patient factors present at index endoscopy were associated with neoplastic progression in BO. Methods: The Rotterdam BO cohort comprises all patients with greater than or equal to3 cm BO, diagnosed at endoscopy between 1973 and 1984. In the present study, only patients with intestinal metaplasia were included (n = 105). Follow-up data were obtained by questionnaires and/or interviews with patients or treating physicians. A Kaplan-Meier analysis was used to estimate 20-year risks. Results: The mean length of the BO was 7.1 cm ( range: 3 - 15 cm). Cancer in BO developed in 6/105 (6%) patients, and high-grade dysplasia (HGD) in 5/105 (5%) patients during 1329 patient-years of follow-up, which equals one cancer case per 221 patient-years and one HGD case per 266 patient-years. After a mean follow-up of 12.7 years, 72 (69%) patients had died; only 4 of them died of oesophageal cancer or its treatment. A longer length of BO was associated with an increased risk of progression to HGD or cancer ( P < 0.02). Six of 24 patients who ever had low-grade dysplasia progressed to HGD or cancer 2 - 16 years after a diagnosis of BO. Conclusions: The annual risk of developing HGD or adenocarcinoma in patients with long-segment BO is 0.83%. Death due to adenocarcinoma is, however, uncommon, even in a cohort of patients with long-segment BO.