Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, The Netherlands.
Gut. 2010 Aug;59(8):1030-6. doi: 10.1136/gut.2009.176701.
Reported incidence rates of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus (BO) vary widely. As the effectiveness of BO surveillance is crucially dependent on this rate, its clarification is essential.
To estimate the rate of malignant progression in patients with BO, all patients with a first diagnosis of BO with no dysplasia (ND) or low-grade dysplasia (LGD) between 1991 and 2006 were identified in the Dutch nationwide registry of histopathology (PALGA). Follow-up data were evaluated up to November 2007.
42 207 patients with BO were included; 4132 (8%) of them had LGD. Re-evaluation endoscopies at least 6 months after initial diagnosis were performed in 16 365 patients (39%), who were significantly younger than those not re-examined (58+/-13 vs 63+/-16 years, p<0.001). These patients were followed-up for a total of 78 131 person-years, during which 666 (4%) high-grade dysplasia (HGD)/OACs occurred, affecting 4% of the surveillance patient population (mean age: 69+/-12 years, 76% male). After excluding HGD/OAC cases detected within 1 year after BO diagnosis (n=212, 32%), incidence rates per 1000 person-years were 4.3 (95% CI 3.4 to 5.5) for OAC and 5.8 (95% CI 4.6 to 7.0) for HGD/OAC combined. Risk factors for HGD/OAC were increased age (eg, >75 years HR 12; 95% CI 8.0 to 18), male sex (2.01; 1.68 to 2.60) and presence of LGD at baseline (1.91; 1.53 to 2.40).
In this largest reported cohort of unselected patients with BO, the annual risk of OAC was 0.4%. Male sex, older age and LGD at diagnosis are independent predictors of malignant progression, and should enable an improved risk assessment in BO.
巴雷特食管（BO）中食管腺癌（OAC）的报告发病率差异很大。由于 BO 监测的有效性主要取决于这一发病率，因此明确其发病率至关重要。
为了估计 BO 患者恶性进展的发生率，在荷兰全国组织病理学登记处（PALGA）中，对 1991 年至 2006 年间首次诊断为 BO 且无异型增生（ND）或低级别异型增生（LGD）的所有患者进行了识别。随访数据评估截止至 2007 年 11 月。
共纳入 42207 例 BO 患者，其中 4132 例（8%）为 LGD。对 16365 例（39%）患者进行了初次诊断后至少 6 个月的复查内镜检查，这些患者明显比未复查的患者年轻（58+/-13 岁 vs 63+/-16 岁，p<0.001）。这些患者共随访了 78131 人年，期间发生了 666 例（4%）高级别异型增生（HGD）/OAC，影响了 4%的监测患者人群（平均年龄：69+/-12 岁，76%为男性）。在排除 BO 诊断后 1 年内检测到的 HGD/OAC 病例（n=212，32%）后，每 1000 人年的 OAC 发生率为 4.3（95%CI 3.4 至 5.5），HGD/OAC 发生率为 5.8（95%CI 4.6 至 7.0）。HGD/OAC 的危险因素包括年龄增加（例如，>75 岁 HR 12；95%CI 8.0 至 18）、男性（2.01；1.68 至 2.60）和基线时存在 LGD（1.91；1.53 至 2.40）。
在这项最大规模的未选择 BO 患者队列报告中，OAC 的年风险为 0.4%。男性、年龄较大和诊断时存在 LGD 是恶性进展的独立预测因素，这应该能够提高 BO 中的风险评估。
