Ma M, Shroff S, Feldman M, DeMarshall M, Price C, Tierney A, Falk G W
Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
Department of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Dis Esophagus. 2017 Mar 1;30(3):1-5. doi: 10.1093/dote/dow025.
Barrett's esophagus is a well-recognized risk factor for esophageal adenocarcinoma. The natural history of Barrett's esophagus classified as ‘indefinite for dysplasia’ (IND) is poorly characterized. The aim of this study is to characterize the natural history of IND by determining the rate of neoplastic progression and identifying risk factors for progression. Patients from the University of Pennsylvania Health System pathology database and Barrett's esophagus registry with a diagnosis of IND between 2000 and 2014 were identified. Exclusion criteria included: (1) prior diagnosis of low-grade dysplasia (LGD), high-grade dysplasia (HGD), or esophageal adenocarcinoma (EAC); (2) presence of LGD, HGD, or EAC at the time of diagnosis of IND; and (3) lack of follow-up endoscopy after diagnosis. Patients with neoplastic progression were classified as having either prevalent disease (LGD, HGD, or EAC on surveillance biopsy within 12 months of IND diagnosis) or incident disease (LGD, HGD, or EAC on surveillance biopsy >12 months after IND diagnosis). One hundred six patients were eligible for analysis. Of 87 patients with follow-up endoscopy and biopsies within 1 year of IND diagnosis, 7 (8%) had prevalent disease (2 LGD, 4 HGD, 1 EAC). The prevalence of LGD was 2.3%, HGD was 4.6%, and EAC was 1.1%. Importantly, four of the seven prevalent (2 LGD, 2 HGD) cases were found to have dysplasia within 6 months of IND diagnosis. No demographic or endoscopic characteristics studied were associated with prevalent disease. Of the 106 IND patients, there were 66 patients without prevalent dysplasia with >1-year follow-up. Three (4.5%) progressed (1 to LGD after 12 months, 2 to HGD after 16.5 and 28 months), yielding an incidence rate for any dysplasia of 1.4 cases/100 person-years and HGD/EAC of 0.9/100 person-years. Risk factors for incident disease were smoking (p = 0.02) and Barrett's esophagus segment length (p = 0.03). IND is associated with considerable risk of prevalent dysplasia, especially within the first 6 months after diagnosis. However, the incidence of HGD/EAC is low and similar to previous studies of IND. These data suggest that IND patients should have repeat endoscopy within 6 months with careful surveillance protocols. Longer BE length and smoking history may help predict which patients are more likely to develop dysplasia, and therefore identify patients who may warrant even closer monitoring.
巴雷特食管是公认的食管腺癌危险因素。分类为“不典型增生不确定”（IND）的巴雷特食管的自然病程特征尚不明确。本研究的目的是通过确定肿瘤进展率和识别进展的危险因素来描述IND的自然病程。从宾夕法尼亚大学医疗系统病理数据库和巴雷特食管登记处中识别出2000年至2014年间诊断为IND的患者。排除标准包括：（1）既往诊断为低级别不典型增生（LGD）、高级别不典型增生（HGD）或食管腺癌（EAC）；（2）在诊断IND时存在LGD、HGD或EAC；（3）诊断后缺乏随访内镜检查。肿瘤进展的患者被分类为患有现患疾病（在IND诊断后12个月内的监测活检中发现LGD、HGD或EAC）或新发疾病（在IND诊断后>12个月的监测活检中发现LGD、HGD或EAC）。106例患者符合分析条件。在IND诊断后1年内进行随访内镜检查和活检的87例患者中，7例（8%）患有现患疾病（2例LGD，4例HGD，1例EAC）。LGD的患病率为2.3%，HGD为4.6%，EAC为1.1%。重要的是，7例现患病例中的4例（2例LGD，2例HGD）在IND诊断后6个月内被发现有不典型增生。所研究的人口统计学或内镜特征均与现患疾病无关。在106例IND患者中，有66例无现患不典型增生且随访时间>1年。3例（4.5%）进展（1例在12个月后进展为LGD，2例分别在16.5个月和28个月后进展为HGD），任何不典型增生的发病率为1.4例/100人年，HGD/EAC为0.9/100人年。新发疾病的危险因素是吸烟（p = 0.02）和巴雷特食管段长度（p = 0.03）。IND与现患不典型增生的相当大风险相关，尤其是在诊断后的前6个月内。然而，HGD/EAC的发病率较低，与先前对IND的研究相似。这些数据表明，IND患者应在6个月内进行重复内镜检查，并采用仔细的监测方案。较长的巴雷特食管长度和吸烟史可能有助于预测哪些患者更有可能发生不典型增生，从而识别可能需要更密切监测的患者。
