A Tissue Systems Pathology Test Detects Abnormalities Associated with Prevalent High-Grade Dysplasia and Esophageal Cancer in Barrett's Esophagus.
A Tissue Systems Pathology Test Detects Abnormalities Associated with Prevalent High-Grade Dysplasia and Esophageal Cancer in Barrett's Esophagus.
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DOI：
10.1158/1055-9965.epi-16-0640
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Falk GW
中科院分区：
文献类型：
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作者：
Critchley-Thorne RJ;Davison JM;Prichard JW;Reese LM;Zhang Y;Repa K;Li J;Diehl DL;Jhala NC;Ginsberg GG;DeMarshall M;Foxwell T;Jobe BA;Zaidi AH;Duits LC;Bergman JJ;Rustgi A;Falk GW
巴雷特食管（BE）患者需要改进检测高级别发育不良（HGD）和食管腺癌（EAC）的工具。在之前的工作中，我们证明了三层分类器预测BE事件进展的风险。我们的目的是确定该风险分类器是否可以检测到非发育不良（ND）的场效应，不确定的异常增生（IND）或低级别异常增生（LGD）活检来自流行HGD/EAC的BE患者。我们进行了一项多机构病例对照研究，以评估先前开发的风险分类器，该分类器基于来自9种生物标志物和形态学的定量图像特征，并预测BE患者HGD/EAC的风险。对重复内镜检查诊断为HGD/EAC的BE患者的ND、IND和LGD活检（流行病例，n=30，诊断为HGD/EAC的中位时间为140.5天）和非进展患者（对照组，n=145，无HGD/EAC的中位监测时间为2015天）的风险分类进行评估。风险分类器将流行病例和非进展患者分为低、中、高风险类别（优势比46.0；95%可信区间14.86-169）；p < 0.0001)。分类器还提供了独立的预后信息，优于亚专科和全科诊断。组织系统病理检查比病理变量更能预测BE患者中流行的HGD/EAC。结果表明，与BE恶性转化相关的分子和细胞变化可以通过使用该测试检测到场效应。组织系统病理学检查可以提供一种客观的方法，以促进早期识别需要治疗干预的BE患者。
There is a need for improved tools to detect high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE). In previous work, we demonstrated that a 3-tier classifier predicted risk of incident progression in BE. Our aim was to determine if this risk classifier could detect a field effect in non-dysplastic (ND), indefinite for dysplasia (IND) or low-grade dysplasia (LGD) biopsies from BE patients with prevalent HGD/EAC. We performed a multi-institutional case-control study to evaluate a previously developed risk classifier that is based upon quantitative image features derived from 9 biomarkers and morphology, and predicts risk for HGD/EAC in BE patients. The risk classifier was evaluated in ND, IND and LGD biopsies from BE patients diagnosed with HGD/EAC on repeat endoscopy (prevalent cases, n=30, median time to HGD/EAC diagnosis 140.5 days) and non-progressors (controls, n=145, median HGD/EAC-free surveillance time 2,015 days). The risk classifier stratified prevalent cases and non-progressor patients into low-, intermediate- and high-risk classes (odds ratio, 46.0; 95% confidence interval, 14.86–169 (high-risk vs low-risk); p<0.0001). The classifier also provided independent prognostic information that outperformed the subspecialist and generalist diagnosis. A tissue systems pathology test better predicts prevalent HGD/EAC in BE patients than pathologic variables. The results indicate that molecular and cellular changes associated with malignant transformation in BE may be detectable as a field effect using the test. A tissue systems pathology test may provide an objective method to facilitate earlier identification of BE patients requiring therapeutic intervention.