Division of Gastroenterology and Hepatology, Barrett's Esophagus Unit, Mayo Clinic, Rochester, MN 55905, USA.
Am J Gastroenterol. 2010 Jul;105(7):1490-1502. doi: 10.1038/ajg.2010.2. Epub 2010 Jan 26.
Barrett's esophagus (BE) is the strongest risk factor for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. EAC is thought to develop through progression of metaplasia to dysplasia to invasive carcinoma. Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention, or ablation for those deemed to be at highest risk of progression. We performed a comprehensive review of the literature and summarized current evidence on risk factors for progression in subjects with known BE. Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and/or EAC in single-center prospective cohort studies. Promising newer techniques and markers have been recently reported with the potential to help risk stratify BE subjects. Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts. Although it would be challenging, creation of such a score has the potential to improve outcomes and make the management of patients with BE more cost-effective.
巴雷特食管（BE）是食管腺癌（EAC）的最强危险因素，EAC 是一种长期预后不良的恶性肿瘤。EAC 被认为是通过化生、异型增生到浸润性癌的进展而发展的。识别预测向 EAC 进展的因素将有助于集中监测、化学预防或消融那些被认为进展风险最高的患者。我们对文献进行了全面综述，并总结了目前已知 BE 患者进展危险因素的证据。在一些研究中，临床和人口统计学因素（年龄、男性、BE 段长度）与向 EAC 进展的几率适度增加相关。在单中心前瞻性队列研究中，生物标志物，如非整倍体和 p53 杂合性丢失，与进展为高级别异型增生和/或 EAC 的风险增加相关。最近有报道称，一些有前途的新技术和标志物具有帮助 BE 患者进行风险分层的潜力。通过多中心前瞻性合作努力，开发一个由临床和生物标志物变量组成的全面 BE 风险进展评分应该是最终目标。尽管这将是具有挑战性的，但创建这样一个评分有可能改善预后并使 BE 患者的管理更具成本效益。
