Sharma Prateek, Falk Gary W, Weston Allan P, Reker Dean, Johnston Mark, Sampliner Richard E
University of Kansas School of Medicine & Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.
Clin Gastroenterol Hepatol. 2006 May;4(5):566-72. doi: 10.1016/j.cgh.2006.03.001. Epub 2006 Apr 17.
BACKGROUND & AIMS: The exact incidence of adenocarcinoma in patients with Barrett's esophagus (BE) is not known and is reported to vary from 0.2%-2% per year. Published series of patients with BE have included relatively small numbers of patients with limited duration of follow-up. The goal of this study was to define the prevalence and incidence of dysplasia and cancer and evaluate the paths of progression in a large multicenter cohort of BE patients.
The BE study is a multicenter clinical and endoscopic outcomes project involving a single large database of patients with BE. Data from each of the participating centers were merged into the main study database. Cancers and HGD occurring within 12 months of the index endoscopy were regarded as prevalent cases.
One thousand three hundred seventy-six patients met the study criteria (95% white, 14% women); 91 patients had cancer at the initial endoscopy (prevalent cases, 6.7%; 95% confidence interval [CI], 4.8%-8.7%). Six hundred eighteen patients were followed for a total of 2546 patient-years; mean follow-up was 4.12 years. Twelve patients developed cancer during follow-up, a cancer incidence of 1 in 212 patient-years of follow-up (0.5% per year; 95% CI, 0%-1.1%). The combined incidence of HGD and/or cancer was 1 in 75 patient-years of follow-up or 1.3% per year (95% CI, 0%-2.2%). Of the 34 patients developing HGD and/or cancer, 18 patients (53%) had at least 2 initial consecutive endoscopies with biopsies revealing nondysplastic mucosa. The incidence of LGD was 4.3% per year (95% CI, 2.8%-6.0%). In the 156 patients with LGD, regression to no dysplasia occurred in 66%, persistent LGD in 21%, and progression to HGD/cancer in 13%. The incidence of cancer in patients with LGD was 1 in 156 patient-years of follow-up or 0.6% per year (95% CI, 0%-1.3%).
Preliminary results from this trial define the prevalence and incidence of dysplasia and cancer in a multicenter cohort of patients with BE. At least half the patients who developed HGD and/or cancer had 2 consecutive initial endoscopies with biopsies revealing nondysplastic mucosa. The majority of patients with LGD regressed and had a cancer incidence similar to all BE patients.
巴雷特食管（BE）患者腺癌的确切发病率尚不清楚，据报道每年在0.2% - 2%之间。已发表的BE患者系列研究纳入的患者数量相对较少，随访时间有限。本研究的目的是确定发育异常和癌症的患病率及发病率，并评估一大群多中心BE患者的疾病进展路径。
BE研究是一个多中心临床和内镜结果项目，涉及一个单一的大型BE患者数据库。每个参与中心的数据都被合并到主要研究数据库中。在首次内镜检查后12个月内发生的癌症和高级别上皮内瘤变（HGD）被视为现患病例。
1376名患者符合研究标准（95%为白人，14%为女性）；91名患者在初次内镜检查时患有癌症（现患病例，6.7%；95%置信区间[CI]，4.8% - 8.7%）。618名患者共随访了2546患者年；平均随访时间为4.12年。12名患者在随访期间发生癌症，癌症发病率为每212患者年1例（每年0.5%；95% CI，0% - 1.1%）。HGD和/或癌症的合并发病率为每75患者年1例或每年1.3%（95% CI，0% - 2.2%）。在34例发生HGD和/或癌症的患者中，18例（53%）至少有2次连续的初次内镜活检，显示黏膜无发育异常。低级别上皮内瘤变（LGD）的发病率为每年4.3%（95% CI，2.8% - 6.0%）。在156例LGD患者中，66%回归为无发育异常，21%持续为LGD，13%进展为HGD/癌症。LGD患者中的癌症发病率为每156患者年1例或每年0.6%（95% CI，0% - 1.3%）。
该试验的初步结果确定了多中心BE患者队列中发育异常和癌症的患病率及发病率。至少一半发生HGD和/或癌症的患者有2次连续的初次内镜活检，显示黏膜无发育异常。大多数LGD患者病情好转，其癌症发病率与所有BE患者相似。
