Gatenby Piers A C, Caygill Christine P J, Ramus James R, Charlett Andre, Fitzgerald Rebecca C, Watson Anthony
Department of Surgery, UK National Barrett's Oesophagus Registry, Royal Free and University College Medical School London, UK.
Eur J Gastroenterol Hepatol. 2007 Nov;19(11):969-75. doi: 10.1097/MEG.0b013e3282c3aa14.
Longer columnar-lined oesophagus (CLO) segments have been associated with higher cancer risk, but few studies have demonstrated a significant difference in neoplastic risk stratified by CLO segment length. This study establishes adenocarcinoma risk in CLO by segment length.
This is a multicentre retrospective observational study. Medical records of 1000 patients registered from six centres were examined and data extracted on demographic factors, endoscopic features and histopathology of oesophageal biopsies. Adenocarcinoma incidence was evaluated for patients stratified by their diagnostic segment length.
Seven hundred and eighty-one patients had biopsy-proven CLO and a segment length recorded. Four hundred and ninety patients had at least 1 year of follow-up, providing 2620 patient-years of follow-up for incidence analysis. The overall annual adenocarcinoma incidence was 0.62%/year (95% confidence interval: 0.36-1.01). The annual incidence in the segment length groups was 0.59% (0.19-1.37) in short segment (<or=3 cm), 0.099% (0.025-0.55) in >3 <or=6 cm, 0.98% (0.27-2.52) in >6 <or=9 cm and 2.0% (0.73-4.35) in >9 cm; P=0.004.
This study demonstrates that the neoplastic risk of CLO varies according to segment length, and that overall, the risk of adenocarcinoma development is similar in short-segment and long-segment (>3 cm) CLO. The highest adenocarcinoma risk was found in the longest CLO segments and lowest risk in segments >3 <or=6 cm.
较长的柱状上皮化生食管（CLO）段与更高的癌症风险相关，但很少有研究表明按CLO段长度分层的肿瘤风险存在显著差异。本研究按段长度确定CLO中的腺癌风险。
这是一项多中心回顾性观察研究。检查了六个中心登记的1000例患者的病历，并提取了有关人口统计学因素、内镜特征和食管活检组织病理学的数据。对按诊断段长度分层的患者评估腺癌发病率。
781例患者经活检证实为CLO并记录了段长度。490例患者至少随访了1年，为发病率分析提供了2620患者年的随访数据。总体腺癌年发病率为0.62%/年（95%置信区间：0.36 - 1.01）。段长度组的年发病率在短段（≤3 cm）为0.59%（0.19 - 1.37），在＞3≤6 cm为0.099%（0.025 - 0.55），在＞6≤9 cm为0.98%（0.27 - 2.52），在＞9 cm为2.0%（0.73 - 4.35）；P = 0.004。
本研究表明，CLO的肿瘤风险因段长度而异，总体而言，短段和长段（＞3 cm）CLO发生腺癌的风险相似。腺癌风险最高的是最长的CLO段，最低的是＞3≤6 cm的段。
