Sinh Preetika, Anaparthy Rajeswari, Young Patrick E, Gaddam Srinivas, Thota Prashanthi, Balasubramanian Gokulakrishnan, Singh Mandeep, Higbee April D, Wani Sachin, Gupta Neil, Rastogi Amit, Mathur Sharad C, Bansal Ajay, Horwhat John D, Cash Brooks D, Falk Gary W, Lieberman David A, Vargo John J, Sampliner Richard E, Sharma Prateek
Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
Endoscopy. 2015 Aug;47(8):669-74. doi: 10.1055/s-0034-1391966. Epub 2015 Apr 24.
Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy.
Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated.
Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar.
Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.
关于诊断为“不典型增生不确定”（IND）的巴雷特食管患者的自然病史数据有限。本研究的目的是：（i）确定进展为高级别不典型增生（HGD）或食管腺癌的发生率，并与低级别不典型增生（LGD）的发生率进行比较；（ii）确定在随访内镜检查中组织学IND诊断发生变化的患者比例。
从一项多中心巴雷特食管研究的数据库中提取诊断为IND和LGD且至少随访12个月的患者的人口统计学、内镜检查和组织学信息。计算进展为HGD和食管腺癌以及回归为无发育异常上皮的发生率和时间。评估在首次随访内镜检查时诊断升级为HGD/食管腺癌或降级为无发育异常上皮的比例。
在2264例患者中，确定了83例诊断为IND的患者（平均年龄60岁，95%为男性，95%为白人；平均随访5.6年）和79例诊断为LGD的患者。在IND组中，食管腺癌和HGD的年发生率分别为0.21%和0.64%，合并发生率为0.8%。进展的平均时间为4.72年。在IND组中，55%的患者在首次随访内镜检查时显示回归为无发育异常上皮，总体回归率为80%。LGD患者的相应发生率相似。
诊断为IND和LGD的病变表现出相似的生物学行为，在监测和随访方面可视为同一类别。
