Incidence of Adenocarcinoma among Patients with Barrett's Esophagus
Incidence of Adenocarcinoma among Patients with Barrett's Esophagus
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DOI：
10.1056/nejmoa1103042
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发表时间：
2011-10-13
影响因子：
158.5
通讯作者：
Funch-Jensen, Peter
中科院分区：
文献类型：
--
作者：
Hvid-Jensen, Frederik;Pedersen, Lars;Funch-Jensen, Peter
准确的人口为基础的数据是需要对食管腺癌和高度异型增生的发病率Barrett's esophageal. METHODS患者中，我们进行了一项全国性的，以人口为基础的，队列研究，涉及所有患者与Barrett's食管在丹麦在1992年至2009年期间，使用丹麦病理学登记处和丹麦癌症登记处的数据。我们确定了腺癌和高度异型增生的发病率（每1000人年的病例数）。作为相对风险的测量，标准化发病率是在研究期间使用丹麦的国家癌症发病率计算的。在索引内窥镜检查后的第一年内，诊断出131例新的腺癌病例。在随后的几年中，检测到66例新的腺癌，腺癌的发病率为1.2例/1000人-年（95%置信区间[CI]，0.9至1.5）。与一般人群的风险相比，Barrett食管患者腺癌的相对风险为11.3（95%CI，8.8至14.4）。食管腺癌的年风险为0.12%（95%CI，0.09 - 0.15）。在索引内镜检查中检测到低度异型增生与腺癌的发病率（5.1例/1000人-年）相关。相比之下，无异型增生患者的发病率为1.0例/1000人-年。高度异型增生患者的风险估计略higher.CONCLUSIONSBarrett食管是食管腺癌的一个强有力的危险因素，但绝对的年风险，0.12%，远低于假设的风险0.5%，这是目前的监测指南的基础。当前研究的数据对持续监测无异型增生的巴雷特食管患者的基本原理提出了质疑。（由丹麦奥胡斯奥胡斯大学临床研究所资助。）
BACKGROUNDAccurate population-based data are needed on the incidence of esophageal adenocarcinoma and high-grade dysplasia among patients with Barrett's esophagus.METHODSWe conducted a nationwide, population-based, cohort study involving all patients with Barrett's esophagus in Denmark during the period from 1992 through 2009, using data from the Danish Pathology Registry and the Danish Cancer Registry. We determined the incidence rates (numbers of cases per 1000 person-years) of adenocarcinoma and high-grade dysplasia. As a measure of relative risk, standardized incidence ratios were calculated with the use of national cancer rates in Denmark during the study period.RESULTSWe identified 11,028 patients with Barrett's esophagus and analyzed their data for a median of 5.2 years. Within the first year after the index endoscopy, 131 new cases of adenocarcinoma were diagnosed. During subsequent years, 66 new adenocarcinomas were detected, yielding an incidence rate for adenocarcinoma of 1.2 cases per 1000 person-years (95% confidence interval [CI], 0.9 to 1.5). As compared with the risk in the general population, the relative risk of adenocarcinoma among patients with Barrett's esophagus was 11.3 (95% CI, 8.8 to 14.4). The annual risk of esophageal adenocarcinoma was 0.12% (95% CI, 0.09 to 0.15). Detection of low-grade dysplasia on the index endoscopy was associated with an incidence rate for adenocarcinoma of 5.1 cases per 1000 person-years. In contrast, the incidence rate among patients without dysplasia was 1.0 case per 1000 person-years. Risk estimates for patients with high-grade dysplasia were slightly higher.CONCLUSIONSBarrett's esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of 0.5%, which is the basis for current surveillance guidelines. Data from the current study call into question the rationale for ongoing surveillance in patients who have Barrett's esophagus without dysplasia. (Funded by the Clinical Institute, University of Aarhus, Aarhus, Denmark.)