Dysplasia and risk of further neoplastic progression in a regional veterans administration Barrett's cohort
Dysplasia and risk of further neoplastic progression in a regional veterans administration Barrett's cohort
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DOI：
10.1111/j.1572-0241.2005.41300.x
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发表时间：
2005-04-01
影响因子：
9.8
通讯作者：
Kahn, KL
中科院分区：
文献类型：
--
作者：
Dulai, GS;Shekelle, PG;Kahn, KL
目的：没有已发表的数据表明，Barrett患者的肿瘤进一步进展的风险是根据基线发育不良状态分层的。我们的目的是估计和比较按基线发育不良状态分层的Barrett患者发展为高度发育不良或癌症的风险。方法：通过地区VA卫生保健系统的病理数据库识别1988-2002年连续的Barrett病例，并提取病历数据。通过生存分析，在内镜检查后1年内测量并比较有和没有低级别不典型增生的患者进展为高级别不典型增生或癌症的风险。结果：共有575例Barrett病例，随访时间为2775患者年。高级别发育不良13例，恶性肿瘤2例。基线不典型增生患者的高级别不典型增生或癌症的粗发生率为78 / 1患者-年，而基线不典型增生患者为278 / 1患者-年（p = 0.001）。每组1例高度发育不良均成功治疗。一例肿瘤成功切除，另一例不能切除。2例高度不典型增生后发展为癌症，1例术后死亡，1例无法切除。当这两个病例被包括在内时（总共四种癌症），基线发育不良者的癌症粗发病率为274例患者-年1例，而基线发育不良者为1114例患者-年1例。结论：在一项大型巴雷特队列研究中，偶发恶性肿瘤并不常见。基线低级别不典型增生的患者进展为高级别不典型增生或癌症的比率明显更高。这些数据可能需要重新评估巴雷特目前的监测策略。
OBJECTIVES: No published data are available on the risk of further neoplastic progression in Barrett's patients stratified by baseline dysplasia status. Our aims were to estimate and compare the risk of progression to high-grade dysplasia or cancer in groups of Barrett's patients stratified by baseline dysplasia status.METHODS: Consecutive Barrett's cases from 1988-2002 were identified via pathology databases in a regional VA health-care system and medical record data were abstracted. The risk of progression to high-grade dysplasia or cancer was measured and compared in cases with versus without low-grade dysplasia within 1 yr of index endoscopy using survival analysis.RESULTS: A total of 575 Barrett's cases had 2,775 patient-years of follow-up. There were 13 incident cases of high-grade dysplasia and two of cancer. The crude rate of high-grade dysplasia or cancer was 1 of 78 patient-years for those with baseline dysplasia versus 1 of 278 patient-years for those without (p = 0.001). One case of high-grade dysplasia in each group underwent successful therapy. One incident cancer case underwent successful resection and the other was unresectable. Two cases with high-grade dysplasia later developed cancer, one died postoperatively, the other was unresectable. When these two cases were included (total of four cancers), the crude rate of cancer was 1 of 274 patient-years for those with baseline dysplasia versus 1 of 1,114 patient-years for those without.CONCLUSIONS: In a large cohort study of Barrett's, incident malignancy was uncommon. The rate of progression to high-grade dysplasia or cancer was significantly higher in those with baseline low-grade dysplasia. These data may warrant reevaluation of current Barrett's surveillance strategies.