Magnitude and Time-Trends of Post-Endoscopy Esophageal Adenocarcinoma and Post-Endoscopy Esophageal Neoplasia in a Population-Based Cohort Study: The Nordic Barrett's Esophagus Study.
Magnitude and Time-Trends of Post-Endoscopy Esophageal Adenocarcinoma and Post-Endoscopy Esophageal Neoplasia in a Population-Based Cohort Study: The Nordic Barrett's Esophagus Study.
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基于人群的队列研究中内窥镜检查后食管腺癌和内窥镜检查后食管肿瘤的程度和时间趋势：北欧巴雷特食管研究。
DOI：
10.1053/j.gastro.2023.05.044
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发表时间：
2023
期刊：
影响因子：
29.4
通讯作者：
Lagergren,Jesper
中科院分区：
文献类型：
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作者：
Wani,Sachin;Holmberg,Dag;Santoni,Giola;Kauppila,JoonasH;Farkkila,Martti;vonEuler-Chelpin,My;Shaheen,NicholasJ;Lagergren,Jesper
背景与目的内镜检查后食管腺癌 (PEEC) 和内镜检查后食管肿瘤 (PEEN) 破坏了巴雷特食管 (BE) 的早期癌症检测。我们的目的是评估新诊断 BE 患者中 PEEC 和 PEEN 的程度并进行时间趋势分析。方法这项基于人群的队列研究于 2006 年至 2020 年间在丹麦、芬兰和瑞典进行，纳入了 20,588 名新诊断 BE 患者。 PEEC 和 PEEN 分别定义为食管腺癌 (EAC) 或高度不典型增生 (HGD)/EAC，在 BE 诊断后 30-365 天诊断（索引内窥镜检查）。对诊断为 0-29 天的 HGD/EAC 和诊断为 BE 诊断后 > 365 天的 HGD/EAC（事件 HGD/EAC）进行了评估。对患者进行随访直至 HGD/EAC、死亡或研究期结束。使用泊松回归计算每 100,000 人年的发病率 (IR)，置信区间 (95% CI) 为 95%。 结果在 293 名诊断为 EAC 的患者中，69 名 (23.5%) 被归类为 PEEC，43 名 (14.7%) 被归类为指数 EAC，181 名 (61.8%) 被归类为偶发 EAC。 PEEC 和事件 EAC 的 IR/100,000 人年分别为 392（95% CI，309-496）和 208（95% CI，180-241）。在诊断为 HGD/EAC 的 279 名患者中（仅限瑞典），17.2% 被归类为 PEEN，14.6% 被归类为指数 HGD/EAC，68.1% 被归类为偶发 HGD/EAC。 PEEN 和事件 HGD/EAC 的 IR/100,000 人年分别为 421 (95% CI, 317–558) 和 285 (95% CI, 247–328)。改变 PEEC/PEEN 发生时间间隔的敏感性分析显示了相似的结果。 IR 的时间趋势分析表明 PEEC/PEEN 的发病率不断上升。结论 对于新诊断的 BE 患者，在上消化道内窥镜检查结果呈阴性后的一年内，几乎四分之一的 EAC 被检测到。改善检测的干预措施可能会降低 PEEC/PEEN 率。
Background & AimsPost-endoscopy esophageal adenocarcinoma (PEEC) and post-endoscopy esophageal neoplasia (PEEN) undermine early cancer detection in Barrett’s esophagus (BE). We aimed to assess the magnitude and conduct time-trend analysis of PEEC and PEEN among patients with newly diagnosed BE.MethodsThis population-based cohort study was conducted in Denmark, Finland, and Sweden between 2006 and 2020 and included 20,588 patients with newly diagnosed BE. PEEC and PEEN were defined as esophageal adenocarcinoma (EAC) or high-grade dysplasia (HGD)/EAC, respectively, diagnosed 30–365 days from BE diagnosis (index endoscopy). HGD/EAC diagnosed from 0–29 days and HGD/EAC diagnosed >365 days from BE diagnosis (incident HGD/EAC) were assessed. Patients were followed up until HGD/EAC, death, or end of study period. Incidence rates (IR) per 100,000 person-years with 95% confidence interval (95% CI) were calculated using Poisson regression.ResultsAmong 293 patients diagnosed with EAC, 69 (23.5%) were categorized as PEEC, 43 (14.7%) as index EAC, and 181 (61.8%) as incident EAC. The IRs/100,000 person-years for PEEC and incident EAC were 392 (95% CI, 309–496), and 208 (95% CI, 180–241), respectively. Among 279 patients diagnosed with HGD/EAC (Sweden only), 17.2% were categorized as PEEN, 14.6% as index HGD/EAC, and 68.1% as incident HGD/EAC. IRs/100,000 person-years for PEEN, and incident HGD/EAC were 421 (95% CI, 317–558), and 285 (95% CI, 247–328), respectively. Sensitivity analyses that varied time interval for occurrence of PEEC/PEEN demonstrated similar results. A time-trend analysis for IRs demonstrated rising incidence rates of PEEC/PEEN.ConclusionsAlmost a quarter of all EACs are detected within a year after an ostensibly negative upper endoscopy in patients with newly diagnosed BE. Interventions to improve detection may reduce PEEC/PEEN rates.