胃食管交界处和 Barrett 食管肠上皮化生的流行病学和自然史：一项基于人群的研究。
Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett's esophagus: a population-based study.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Am J Gastroenterol. 2011 Aug;106(8):1447-55; quiz 1456. doi: 10.1038/ajg.2011.130. Epub 2011 Apr 12.
OBJECTIVES
Population-based data on the epidemiology and outcomes of subjects with intestinal metaplasia of the gastroesophageal junction (IMGEJ) and Barrett's esophagus (BE) are limited. The objectives of this study were to (i) estimate the incidence of IMGEJ and BE diagnosed from clinically indicated endoscopy in Olmsted County, MN, over three decades (1976-2006) and prevalence as of 1 January 2007, (ii) compare baseline characteristics of subjects with IMGEJ and BE, and (iii) study the natural history and survival of both cohorts.
METHODS
This was a population-based cohort study. The study setting was Olmsted County, MN. Patients with BE (columnar segment >1 cm with intestinal metaplasia) and IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) from 1976 to 2006 in Olmsted County, MN, were identified using Rochester Epidemiology Project resources. Demographic and clinical data were abstracted from medical records and pathology confirmed by gastrointestinal pathologists. The association of baseline characteristics with overall and progression-free survival was assessed using proportional hazards regression models. Outcome measures were baseline characteristics and overall survival of subjects with IMGEJ compared to those with BE.
RESULTS
In all, 487 patients (401 with BE and 86 with IMGEJ) were identified and followed for a median interval of 7 (BE subjects) to 8 (IMGEJ subjects) years. Subjects with BE were older, heavier, reported reflux symptoms more often, and had higher prevalence of advanced neoplasia than those with IMGEJ. No patient with IMGEJ progressed to esophageal adenocarcinoma (EAC) in contrast to BE subjects who had a cumulative risk of progression of 7% at 10 years and increased risk of death from EAC (standardized mortality ratio 9.62). The overall survival of subjects with BE and IMGEJ did not differ from that expected in similar age- and sex-distributed white Minnesota populations.
CONCLUSIONS
Subjects with IMGEJ appear to have distinct clinical characteristics and substantially lower cancer progression risk compared to those with BE.
目的
有关胃食管交界处（GEJ）肠化生（IMGEJ）和巴雷特食管（BE）患者的流行病学和结局的基于人群的数据有限。本研究的目的是：（i）估计在明尼苏达州奥姆斯特德县（MN），通过临床指征性内镜检查诊断出的 IMGEJ 和 BE 的发病率，以及截至 2007 年 1 月 1 日的患病率；（ii）比较 IMGEJ 和 BE 患者的基线特征；（iii）研究两个队列的自然病史和生存率。
方法
这是一项基于人群的队列研究。研究地点为明尼苏达州奥姆斯特德县。使用罗切斯特流行病学项目资源，在 MN 奥姆斯特德县，从 1976 年至 2006 年期间，识别出 BE（柱状段>1cm 伴肠化生）和 IMGEJ（GEJ 活检中的肠化生）患者。从病历中提取人口统计学和临床数据，并由胃肠病理学家确认病理学。使用比例风险回归模型评估基线特征与总生存率和无进展生存率之间的关联。主要终点为 IMGEJ 患者与 BE 患者的基线特征和总生存率。
结果
共确定了 487 例患者（401 例 BE，86 例 IMGEJ），并进行了中位数为 7 年（BE 患者）至 8 年（IMGEJ 患者）的随访。与 IMGEJ 患者相比，BE 患者年龄更大、体重更重、更常报告反流症状，且高级别肿瘤的患病率更高。与 BE 患者相比，没有 IMGEJ 患者进展为食管腺癌（EAC），而 BE 患者在 10 年内进展为 EAC 的累积风险为 7%，EAC 导致死亡的风险增加（标准化死亡率比 9.62）。BE 和 IMGEJ 患者的总生存率与相似年龄和性别分布的明尼苏达州白人人群预期的生存率没有差异。
结论
与 BE 患者相比，IMGEJ 患者的临床特征明显不同，癌症进展风险也明显更低。
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