Department of Gastroenterology, VA Medical Center, White River Junction, Vermont, USA Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder, Regensburg, Germany.
Gut. 2016 Feb;65(2):196-201. doi: 10.1136/gutjnl-2015-309220. Epub 2015 Jun 25.
OBJECTIVE: Although it is well understood that the risk of oesophageal adenocarcinoma increases with Barrett length, transition risks for cancer associated with different Barrett lengths are unknown. We aimed to estimate annual cancer transition rates for patients with long-segment (≥3 cm), short-segment (≥1 to <3 cm) and ultra-short-segment (<1 cm) Barrett's oesophagus. DESIGN: We used three data sources to estimate the annual cancer transition rates for each Barrett length category: (1) the distribution of long, short and ultra-short Barrett's oesophagus among a large German cohort with newly diagnosed T1 oesophageal adenocarcinoma; (2) population-based German incidence of oesophageal adenocarcinoma; and (3) published estimates of the population prevalence of Barrett's oesophagus for each Barrett length category. RESULTS: Among 1017 patients with newly diagnosed T1 oesophageal adenocarcinoma, 573 (56%) had long-segment, 240 (24%) short-segment and 204 (20%) ultra-short-segment Barrett's oesophagus. The base-case estimates for the prevalence of Barrett's oesophagus among the general population were 1.5%, 5% and 14%, respectively. The annual cancer transition rates for patients with long, short and ultra-short Barrett's oesophagus were 0.22%, 0.03% and 0.01%, respectively. To detect one cancer, 450 patients with long-segment Barrett's oesophagus would need to undergo annual surveillance endoscopy; in short segment and ultra-short segment, the corresponding numbers of patients would be 3440 and 12,364. Similar results were obtained when applying US incidence data. CONCLUSIONS: The large number of patients, who need to undergo endoscopic surveillance to detect one cancer, raises questions about the value of surveillance endoscopy in patients with short segment or ultra-short segment of Barrett's oesophagus.
目的：虽然人们已经充分认识到食管腺癌的风险随着 Barrett 长度的增加而增加，但不同 Barrett 长度相关的癌症转化风险尚不清楚。本研究旨在评估长节段（≥3cm）、短节段（≥1cm 且<3cm）和超短节段（<1cm）Barrett 食管患者的年度癌症转化率。
设计：我们使用三个数据源来估计每个 Barrett 长度类别的年度癌症转化率：（1）在一个新诊断为 T1 食管腺癌的大型德国队列中，长节段、短节段和超短节段 Barrett 食管的分布；（2）基于人群的德国食管腺癌发病率；（3）发表的每个 Barrett 长度类别的 Barrett 食管人群患病率估计值。
结果：在 1017 例新诊断的 T1 食管腺癌患者中，573 例（56%）为长节段，240 例（24%）为短节段，204 例（20%）为超短节段 Barrett 食管。一般人群中 Barrett 食管患病率的基本情况估计值分别为 1.5%、5%和 14%。长、短和超短节段 Barrett 食管患者的年度癌症转化率分别为 0.22%、0.03%和 0.01%。为了发现一例癌症，需要对 450 例长节段 Barrett 食管患者进行年度内镜监测；在短节段和超短节段，需要监测的患者数量分别为 3440 例和 12364 例。当应用美国发病率数据时，得到了类似的结果。
结论：需要进行内镜监测才能发现一例癌症的大量患者，这使得短节段或超短节段 Barrett 食管患者进行监测的价值受到质疑。
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