Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences Building, Belfast BT12 6BA, Northern Ireland, UK.
J Natl Cancer Inst. 2011 Jul 6;103(13):1049-57. doi: 10.1093/jnci/djr203. Epub 2011 Jun 16.
Barrett's esophagus (BE) is a premalignant lesion that predisposes to esophageal adenocarcinoma. However, the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett's esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005.
We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General's Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests.
After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P < .001), in men compared with women (0.28% per year vs 0.13% per year; HR = 2.11, 95% CI = 1.41 to 3.16, P < .001), and in patients with low-grade dysplasia compared with no dysplasia (1.40% per year vs 0.17% per year; HR = 5.67, 95% CI = 3.77 to 8.53, P < .001).
We found the risk of malignant progression among patients with BE to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective.
巴雷特食管（BE）是一种癌前病变，易引发食管腺癌。然而，BE 患者中食管腺癌的报告发病率差异很大。我们利用北爱尔兰 Barrett 食管注册中心（NIBR）的数据来研究 BE 患者恶性进展的风险，该中心是世界上最大的基于人群的 BE 注册中心之一，涵盖了 1993 年至 2005 年间北爱尔兰每一位被诊断为 BE 的成年人。
我们对 8522 例 BE 患者进行了随访，BE 定义为食管柱状上皮伴有或不伴有特殊肠化生（SIM）。直到 2008 年底，我们通过将 NIBR 与北爱尔兰癌症登记处相匹配来确定新发食管或胃贲门腺癌或食管高级别上皮内瘤变的患者，并通过与登记总干事办公室的记录相匹配来确定死亡患者。通过 Cox 比例风险模型，以每 100 人年的癌症结局或高级别上皮内瘤变发生率（%/年）来计算癌症发生率，并按年龄、性别、BE 段长度、是否存在 SIM、大体 BE 或低级别上皮内瘤变来确定发病率。所有 P 值均为双侧检验。
在平均 7.0 年的随访后，79 例患者被诊断为食管癌，16 例为贲门癌，36 例为高级别上皮内瘤变。在整个队列中，食管或胃贲门癌或高级别上皮内瘤变联合发生率为 0.22%/年（95%置信区间[CI]：0.19%至 0.26%）。46.0%的患者存在 SIM。在存在 SIM 的患者中，联合发生率为 0.38%/年（95%CI：0.31%至 0.46%）。与索引活检时无 SIM 的患者相比，有 SIM 的患者的癌症风险显著升高（0.38%/年 vs. 0.07%/年；风险比[HR] = 3.54，95%CI：2.09 至 6.00，P <.001），男性与女性相比（0.28%/年 vs. 0.13%/年；HR = 2.11，95%CI：1.41 至 3.16，P <.001），以及低级别上皮内瘤变与无上皮内瘤变相比（1.40%/年 vs. 0.17%/年；HR = 5.67，95%CI：3.77 至 8.53，P <.001）。
我们发现 BE 患者的恶性进展风险低于之前的报告，这表明目前推荐的监测策略可能没有成本效益。
