Verbeek Romy E, Leenders Max, Ten Kate Fiebo J W, van Hillegersberg Richard, Vleggaar Frank P, van Baal Jantine W P M, van Oijen Martijn G H, Siersema Peter D
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Gastroenterol. 2014 Aug;109(8):1215-22. doi: 10.1038/ajg.2014.156. Epub 2014 Jul 1.
Barrett's esophagus (BE) is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Patients with a known diagnosis of BE are usually advised to participate in an endoscopic surveillance program, but its clinical value is unproven. Our objective was to compare patients participating in a surveillance program for BE before EAC diagnosis with those not participating in such a program, and to determine predictive factors for mortality from EAC.
All patients diagnosed with EAC between 1999 and 2009 were identified in the nationwide Netherlands Cancer Registry. These data were linked to Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief, the Dutch Pathology Registry. Prior surveillance was evaluated, and multivariable Cox proportional hazards regression analysis was performed to identify predictors for all-cause mortality at 2-year and 5-year follow-up.
In total, 9,780 EAC patients were included. Of these, 791 (8%) patients were known with a prior diagnosis of BE, of which 452 (57%) patients participated in an adequate endoscopic surveillance program, 120 (15%) patients in an inadequate program, and 219 (28%) patients had a prior BE diagnosis without participating. Two-year (and five-year) mortality rates were lower in patients undergoing adequate surveillance (adjusted hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.64-0.92) when compared with patients with a prior BE diagnosis who were not participating. Other factors associated with lower mortality from EAC were lower tumor stage (stage I vs. IV, HR=0.19, 95% CI=0.16-0.23) and combining surgery with neoadjuvant chemo/radiotherapy (HR=0.66, 95% CI=0.58-0.76).
Participation in a surveillance program for BE, but only if adequately performed, reduces mortality from EAC. Nevertheless, it remains to be determined whether such a program is cost-effective, as more than 90% of all EAC patients were not known to have BE before diagnosis.
巴雷特食管（BE）与食管腺癌（EAC）发生风险增加相关。已知诊断为BE的患者通常被建议参加内镜监测项目，但其临床价值尚未得到证实。我们的目的是比较在EAC诊断前参加BE监测项目的患者与未参加该项目的患者，并确定EAC死亡的预测因素。
在荷兰全国癌症登记处识别出1999年至2009年间所有诊断为EAC的患者。这些数据与荷兰病理登记处Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief相关联。评估先前的监测情况，并进行多变量Cox比例风险回归分析，以确定2年和5年随访时全因死亡率的预测因素。
共纳入9780例EAC患者。其中，791例（8%）患者先前已知诊断为BE，其中452例（57%）患者参加了充分的内镜监测项目，120例（15%）患者参加的项目不充分，219例（28%）患者先前有BE诊断但未参加。与未参加的先前有BE诊断的患者相比，接受充分监测的患者2年（和5年）死亡率较低（调整后的风险比（HR）=0.79，95%置信区间（CI）=0.64-0.92）。与EAC死亡率较低相关的其他因素包括肿瘤分期较低（I期与IV期，HR=0.19，95%CI=0.16-0.23）以及手术联合新辅助化疗/放疗（HR=0.66，95%CI=0.58-0.76）。
参加BE监测项目，但仅在执行充分时，可降低EAC死亡率。然而，由于超过90%的EAC患者在诊断前未知患有BE，该项目是否具有成本效益仍有待确定。
Zotero 插件