Gatenby Piers, Ramus James, Caygill Christine, Shepherd Neil, Winslet Marc, Watson Anthony
UK National Barrett's Oesophagus Registry, University Department of Surgery, Royal Free and University College Medical School, London, UK.
Histopathology. 2009 Jun;54(7):814-9. doi: 10.1111/j.1365-2559.2009.03316.x.
To examine the natural history of columnar-lined oesophagus with routinely diagnosed low-grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development.
A multicentre retrospective cohort study of 283 patients with low-grade dysplasia. Follow-up data were obtained from examination of hospital records. One hundred and forty-four patients had biopsies prior to low-grade dysplasia diagnosis and 217 had follow-up biopsies after index low-grade dysplasia diagnosis. In these patients the incidence of high-grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow-up, 43 (19.8%) had persistent low-grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non-dysplastic columnar-lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low-grade dysplasia diagnosis), the annual incidence of high-grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low-grade dysplasia compared with non-dysplastic columnar-lined oesophagus was 2.871 (P = 0.002).
Low-grade dysplasia has a threefold increased risk of progression to cancer compared with non-dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.
研究常规诊断为低度异型增生的柱状上皮食管的自然病程，并确定食管腺癌发生的风险。
对283例低度异型增生患者进行多中心回顾性队列研究。随访数据来自医院记录检查。144例患者在低度异型增生诊断前进行了活检，217例在首次低度异型增生诊断后进行了随访活检。在这些患者中，高级别异型增生和腺癌合并发生率为每年4.6%，单独腺癌发生率为每年2.7%。在最近一次随访时，43例（19.8%）为持续性低度异型增生，37例（17.1%）异型增生情况不确定，108例（49.8%）为无异型增生的柱状上皮食管。排除现患病例（首次低度异型增生诊断后1年内发生的病例）后，高级别异型增生和腺癌合并年发生率为2.2%，单独腺癌年发生率为1.4%。与无异型增生的柱状上皮食管相比，低度异型增生发展为腺癌的相对风险为2.871（P = 0.002）。
与无异型增生的上皮相比，低度异型增生进展为癌症的风险增加了两倍，但在大多数患者中，随后未检测到异型增生。
