Surveillance of Barrett's Esophagus and Mortality from Esophageal Adenocarcinoma: A Population-Based Cohort Study
Surveillance of Barrett's Esophagus and Mortality from Esophageal Adenocarcinoma: A Population-Based Cohort Study
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DOI：
10.1038/ajg.2014.156
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发表时间：
2014-08-01
影响因子：
9.8
通讯作者：
Siersema, Peter D.
中科院分区：
文献类型：
--
作者：
Verbeek, Romy E.;Leenders, Max;Siersema, Peter D.
目的：Barrett‘s食道(BE)与发生食管腺癌(EAC)的风险增加有关。确诊为BE的患者通常被建议参加内窥镜监测计划，但其临床价值尚未得到证实。我们的目标是比较在EAC确诊前参加BE监测计划的患者和未参加此类计划的患者，并确定EAC.EAC死亡率的预测因素。方法：在全国范围内的荷兰癌症登记处确认了1999至2009年间所有被诊断为EAC的患者。这些数据被链接到荷兰病理登记处的病理解剖学-Landelijk GeAutomatiseerd Arhead。对先前的监测进行评估，并进行多变量COX比例风险回归分析，以确定2年和5年随访时全因死亡率的预测因素。结果：总共纳入9,780名EAC患者。在这些患者中，791名(8%)患者已知有BE的先前诊断，其中452名(57%)患者参加了充分的内窥镜监测计划，120名(15%)患者参加了不充分的计划，219名(28%)患者在没有参与的情况下有BE先前诊断。接受充分监测(调整风险比(HR)=0.79，95%可信区间(CI)=0.64-0.92)的患者的两年(和五年)死亡率低于没有参与监测的既往BE患者。其他与EAC死亡率降低相关的因素包括较低的肿瘤分期(I期与IV期，HR=0.19，95%CI=0.16-0.23)和手术结合新辅助化疗/放疗(HR=0.66，95%CI=0.58-0.76)。结论：参与BE的监测项目，但只有在充分执行的情况下，才能降低EAC的死亡率。然而，这种方案是否具有成本效益仍有待确定，因为超过90%的EAC患者在确诊前并不知道。
OBJECTIVES: Barrett's esophagus (BE) is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Patients with a known diagnosis of BE are usually advised to participate in an endoscopic surveillance program, but its clinical value is unproven. Our objective was to compare patients participating in a surveillance program for BE before EAC diagnosis with those not participating in such a program, and to determine predictive factors for mortality from EAC.METHODS: All patients diagnosed with EAC between 1999 and 2009 were identified in the nationwide Netherlands Cancer Registry. These data were linked to Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief, the Dutch Pathology Registry. Prior surveillance was evaluated, and multivariable Cox proportional hazards regression analysis was performed to identify predictors for all-cause mortality at 2-year and 5-year follow-up.RESULTS: In total, 9,780 EAC patients were included. Of these, 791 (8%) patients were known with a prior diagnosis of BE, of which 452 (57%) patients participated in an adequate endoscopic surveillance program, 120 (15%) patients in an inadequate program, and 219 (28%) patients had a prior BE diagnosis without participating. Two-year (and five-year) mortality rates were lower in patients undergoing adequate surveillance (adjusted hazard ratio (HR) = 0.79, 95% confidence interval (CI) = 0.64-0.92) when compared with patients with a prior BE diagnosis who were not participating. Other factors associated with lower mortality from EAC were lower tumor stage (stage I vs. IV, HR = 0.19, 95% CI = 0.16-0.23) and combining surgery with neoadjuvant chemo/radiotherapy (HR = 0.66, 95% CI = 0.58-0.76).CONCLUSIONS: Participation in a surveillance program for BE, but only if adequately performed, reduces mortality from EAC. Nevertheless, it remains to be determined whether such a program is cost-effective, as more than 90% of all EAC patients were not known to have BE before diagnosis.