Yousef Fouad, Cardwell Chris, Cantwell Marie M, Galway Karen, Johnston Brian T, Murray Liam
Cancer Epidemiology and Prevention Research Group, Centre for Clinical and Population Sciences, Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom.
Am J Epidemiol. 2008 Aug 1;168(3):237-49. doi: 10.1093/aje/kwn121. Epub 2008 Jun 12.
Barrett's esophagus is a well-recognized precursor of esophageal adenocarcinoma. Surveillance of Barrett's esophagus patients is recommended to detect high-grade dysplasia (HGD) or early cancer. Because of wide variation in the published cancer incidence in Barrett's esophagus, the authors undertook a systematic review and meta-analysis of cancer and HGD incidence in Barrett's esophagus. Ovid Medline (Ovid Technologies, Inc., New York, New York) and EMBASE (Elsevier, Amsterdam, the Netherlands) databases were searched for papers published between 1950 and 2006 that reported the cancer/HGD risk in Barrett's esophagus. Where possible, early incident cancers/HGD were excluded, as were patients with HGD at baseline. Forty-seven studies were included in the main analysis, and the pooled estimate for cancer incidence in Barrett's esophagus was 6.1/1,000 person-years, 5.3/1,000 person-years when early incident cancers were excluded, and 4.1/1,000 person-years when both early incident cancer and HGD at baseline were excluded. Corresponding figures for combined HGD/cancer incidence were 10.0 person-years, 9.3 person-years, and 9.1/1,000 person-years. Compared with women, men progressed to cancer at twice the rate. Cancer or HGD/cancer incidences were lower when only high-quality studies were analyzed (3.9/1,000 person-years and 7.7/1,000 person-years, respectively). The pooled estimates of cancer and HGD incidence were low, suggesting that the cost-effectiveness of surveillance is questionable unless it can be targeted to those with the highest cancer risk.
巴雷特食管是一种公认的食管腺癌癌前病变。建议对巴雷特食管患者进行监测，以检测高级别上皮内瘤变（HGD）或早期癌症。由于巴雷特食管已发表的癌症发病率差异很大，作者对巴雷特食管的癌症和HGD发病率进行了系统评价和荟萃分析。检索了Ovid Medline（纽约州纽约市Ovid Technologies公司）和EMBASE（荷兰阿姆斯特丹爱思唯尔公司）数据库中1950年至2006年间发表的报告巴雷特食管癌症/HGD风险的论文。在可能的情况下，排除早期发生的癌症/HGD以及基线时患有HGD的患者。47项研究纳入主要分析，巴雷特食管癌症发病率的合并估计值为6.1/1000人年，排除早期发生的癌症时为5.3/1000人年，排除早期发生的癌症和基线时的HGD时为4.1/1000人年。HGD/癌症合并发病率的相应数字分别为10.0/1000人年、9.3/1000人年和9.1/1000人年。与女性相比男性进展为癌症的速度是女性的两倍。仅分析高质量研究时，癌症或HGD/癌症发病率较低（分别为3.9/1000人年和7.7/1000人年）。癌症和HGD发病率合并估计值较低，这表明除非能针对癌症风险最高的人群进行监测，否则监测的成本效益值得怀疑。
