Department of Pathology, University of Padova, Padua, Italy.
Ann Surg. 2012 Nov;256(5):788-94; discussion 794-5. doi: 10.1097/SLA.0b013e3182737a7e.
To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)].
BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer.
In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression.
HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN.
These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.
在食管肠上皮化生（BE）的前瞻性队列中建立进展为高级别上皮内瘤变（HG-IEN）或 Barrett 食管腺癌（BAc）的发生率和危险因素。
BE 与 BAc 的风险增加有关，除非通过监测及早发现病例。目前尚无关于 BE 相关癌症的患病率、理想的监测方案或癌症危险因素的一致数据。
2003 年，在意大利东北部建立了一个 BE 患者的区域登记处，制定了相关的诊断标准（内镜标志、活检方案、组织学分类）和随访时间（根据组织学量身定制），并记录患者的结局。涉及 13 个中心，并每年进行审核。使用 Kaplan-Meier 法计算进展为 HG-IEN/BAc 的概率；使用 Cox 回归模型计算进展的风险。
索引内镜或随访的第 1 年内发现的 HG-IEN（10 例）和 EAc（7 例）被认为是先前存在疾病的病例并被排除在外；841 例至少有 2 次内镜检查的患者[中位数，3 [四分位距（IQR）：2-4]；中位随访=44.6 [IQR：24.7-60.5]个月；总 3083 患者年]构成研究组[男/女=646/195；中位年龄，60（IQR：51-68）岁]。22 例患者在中位 40.2（26.9-50.4）个月后进展为 HG-IEN 或 BAc（发生率：每 100 患者年 0.72 例）。多变量分析显示，内镜异常，即溃疡或结节（P=0.0002；相对风险[RR] = 7.6；95%置信区间，2.63-21.9）、LG-IEN（P=0.02，RR=3.7；95%置信区间，1.22-11.43）和 BE 长度（P=0.01；RR=1.16；95%置信区间，1.03-1.30）与 BE 进展相关。在 LG-IEN 患者中，HG-IEN/EAc 的发生率为 3.17 患者年，即高于无 LG-IEN 的 BE 患者的 6 倍。
这些结果表明，在没有上皮内瘤变的情况下，BE 进展为 HG-IEN/BAc 的风险较低，对于有内镜异常、LG-IEN 或较长 BE 段的患者，应进行严格监测（或消融治疗）。
