Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif 90033, USA.
J Thorac Cardiovasc Surg. 2013 Jul;146(1):31-7. doi: 10.1016/j.jtcvs.2012.12.058. Epub 2013 Jan 11.
Surveillance endoscopy has been recommended for patients with Barrett's esophagus; however, recent studies have questioned the importance owing to the new, lower, estimates of the rate of progression of Barrett's esophagus to cancer. The aim of the present study was to compare the tumor stage, survival, and frequency of esophageal preservation in patients who presented with progression of Barrett's esophagus within a surveillance program versus those who presented with prevalent disease.
A retrospective chart review was performed of all patients treated for high-grade dysplasia or esophageal adenocarcinoma from 2005 to 2010. The surveillance group included patients who had had at least 1 endoscopy and biopsy confirming intestinal metaplasia (with or without low-grade dysplasia) 6 months or more before the endoscopy showing progression.
A total of 224 patients were included in the present study, 36 in the surveillance group and 188 in the prevalence group. The surveillance patients had significantly earlier stage tumors (P < .0001) and were more likely to undergo endoscopic therapy and to keep their esophagus (44% vs 11%, P < .0001) than were patients with prevalent disease. Furthermore, the patients in the surveillance group were less likely to have lymph node metastases and had better overall and disease-free survival. No patient with high-grade dysplasia or an intramucosal tumor died of cancer.
Patients within a surveillance program for Barrett's esophagus had better survival and were less likely to have an esophagectomy than those who presented with prevalent disease. Treatment of intramucosal cancer was curative, and improved survival with surveillance was not secondary to lead time bias. Surveillance endoscopy remains important in patients with Barrett's esophagus.
鉴于 Barrett 食管进展为癌症的新的、较低的估计率，监测内镜检查已被推荐用于 Barrett 食管患者；然而，最近的研究对此提出了质疑。本研究的目的是比较在监测计划中出现 Barrett 食管进展的患者与出现现有疾病的患者的肿瘤分期、生存和食管保留率。
对 2005 年至 2010 年间因高级别异型增生或食管腺癌接受治疗的所有患者进行了回顾性图表审查。监测组包括至少进行过 1 次内镜检查和活检以确认肠化生（伴有或不伴有低级别异型增生）6 个月或以上的患者，然后在内镜检查显示进展之前进行了内镜检查。
本研究共纳入 224 例患者，其中 36 例在监测组，188 例在流行组。监测患者的肿瘤分期明显更早（P < 0.0001），并且更有可能接受内镜治疗并保留食管（44% vs. 11%，P < 0.0001），而流行组患者则较少。此外，监测组患者淋巴结转移的可能性较低，总生存和无病生存情况更好。无高等级异型增生或黏膜内肿瘤患者死于癌症。
与流行疾病患者相比，Barrett 食管监测计划内的患者具有更好的生存机会，并且不太可能需要进行食管切除术。黏膜内癌的治疗是治愈性的，监测导致生存改善并不是由于领先时间偏倚。监测内镜检查在 Barrett 食管患者中仍然很重要。
