Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
Gastroenterology. 2015 Dec;149(7):1752-1761.e1. doi: 10.1053/j.gastro.2015.08.048. Epub 2015 Aug 29.
BACKGROUND & AIMS: Radiofrequency ablation (RFA) is commonly used to treat Barrett's esophagus (BE). We assessed the incidence of esophageal adenocarcinoma (EAC) after RFA, factors associated with the development of EAC, and EAC-specific and all-cause mortality.
We collected data for outcomes of patients who underwent RFA for BE from July 2007 through July 2011 from US multicenter RFA Patient Registry. Patients were followed until July 2014. Kaplan-Meier curves of EAC incidence were stratified by baseline histology. Crude EAC incidence and mortality (all-cause and EAC-specific) were calculated, and adjusted all-cause mortality was assessed. Logistic regression models were constructed to assess predictors of EAC and all-cause mortality.
Among 4982 patients, 100 (2%) developed EAC (7.8/1000 person-years [PY]) and 9 patients (0.2%) died of EAC (0.7/1000 PY) in a mean 2.7 ± 1.6 years. The incidence of EAC in nondysplastic BE was 0.5/1000 PY. Overall, 157 patients (3%) died during follow-up (all-cause mortality, 11.2/1000 PY). On multivariate logistic regression, baseline BE length (odds ratio, 1.1/ cm) and baseline histology (odds ratios, 5.8 and 50.3 for low-grade dysplasia and high-grade dysplasia [HGD] respectively) predicted EAC incidence. Among 9 EAC deaths, 6 (67%) had baseline HGD, and 3 (33%) had baseline intramucosal EAC. The most common causes of death were cardiovascular (15%) and extraesophageal cancers (15%). No deaths were associated with RFA.
Based on analysis of a multicenter registry of patients who underwent RFA of BE, less than 1% died from EAC. The incidence of EAC was markedly lower in this study than in other studies of disease progression, with the greatest absolute benefit observed in patients with HGD.
射频消融术（RFA）常用于治疗 Barrett 食管（BE）。我们评估了 RFA 后食管腺癌（EAC）的发生率、与 EAC 发生相关的因素，以及 EAC 特异性和全因死亡率。
我们从 2007 年 7 月至 2011 年 7 月收集了在美国多中心 RFA 患者登记处接受 RFA 治疗的 BE 患者结局的数据。患者随访至 2014 年 7 月。根据基线组织学，对 EAC 发生率的 Kaplan-Meier 曲线进行分层。计算了 EAC 的粗发病率和死亡率（全因和 EAC 特异性），并评估了调整后的全因死亡率。构建了逻辑回归模型来评估 EAC 和全因死亡率的预测因素。
在 4982 名患者中，100 名（2%）发生了 EAC（7.8/1000 人年[PY]），9 名患者（0.2%）死于 EAC（0.7/1000 PY），平均随访时间为 2.7±1.6 年。非异型增生性 BE 的 EAC 发生率为 0.5/1000 PY。总的来说，157 名患者（3%）在随访期间死亡（全因死亡率为 11.2/1000 PY）。在多变量逻辑回归中，基线 BE 长度（比值比，每增加 1 厘米为 1.1）和基线组织学（低级别异型增生和高级别异型增生的比值比分别为 5.8 和 50.3）预测了 EAC 的发生率。在 9 例 EAC 死亡中，6 例（67%）患者基线时为 HGD，3 例（33%）患者基线时为黏膜内 EAC。最常见的死亡原因是心血管疾病（15%）和食管外癌症（15%）。没有与 RFA 相关的死亡。
基于对接受 BE 射频消融术的多中心患者登记处的分析，不到 1%的患者死于 EAC。本研究中 EAC 的发生率明显低于其他疾病进展研究，在 HGD 患者中观察到的绝对获益最大。
