Holmberg Dag, Ness-Jensen Eivind, Mattsson Fredrik, El-Serag Hashem B, Lagergren Jesper
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, NS 67, 171 76 Stockholm, Sweden.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Eur J Cancer. 2017 Apr;75:41-46. doi: 10.1016/j.ejca.2016.12.037. Epub 2017 Feb 17.
Recent studies have indicated a lower incidence rate of oesophageal adenocarcinoma (OAC) in individuals with Barrett's oesophagus (BO) than most earlier studies. Our objective was to assess the risk of OAC in a Swedish unselected cohort of individuals with BO.
This population-based cohort study included all Swedish residents diagnosed with BO in 2006-2013, identified through the Swedish Patient Registry. The cohort members were followed from the date of first BO diagnosis until the first occurrence of OAC, high-grade dysplasia (HGD), death, emigration or end of study period. The main outcome was incidence rates with 95% confidence intervals (CIs) of OAC.
Among 7932 participants with BO and 18,415 person-years of follow-up, the overall incidence of OAC was 1.47 (95% CI 0.91-2.02) per 1000 person-years. When stratified into follow-up periods after BO diagnosis, the incidence rate of OAC was 15.53 (4.77-26.29) from 7 to 30 d, 4.10 (0.82-7.38) from 31 to 100 d, 1.87 (0.00-3.99) from 101 d to 6 months, 1.44 (0.18-2.70) from >6 months to 1 year, 0.94 (0.36-1.53) from >1 year to 3 years and 2.17 (1.14-3.21) from >3 years to the end of follow-up. The median follow-up time was 2.13 person-years.
This population-based study indicates that OAC is primarily diagnosed during the first months following an initial diagnosis of BO. This could justify a changed surveillance strategy of BO with a repeated thorough endoscopy shortly after initial BO diagnosis to identify prevalent early OAC or HGD.
最近的研究表明，巴雷特食管（BO）患者的食管腺癌（OAC）发病率低于大多数早期研究。我们的目的是评估瑞典一个未经选择的BO患者队列中OAC的风险。
这项基于人群的队列研究纳入了2006年至2013年期间通过瑞典患者登记处确诊为BO的所有瑞典居民。队列成员从首次诊断为BO之日起随访，直至首次发生OAC、高级别异型增生（HGD）、死亡、移民或研究期结束。主要结局是OAC的发病率及95%置信区间（CI）。
在7932名BO参与者及18415人年的随访中，OAC的总体发病率为每1000人年1.47（95%CI 0.91 - 2.02）。按BO诊断后的随访期分层时，OAC发病率在诊断后7至30天为15.53（4.77 - 26.29），31至100天为4.10（0.82 - 7.38），101天至6个月为1.87（0.00 - 3.99），6个月以上至1年为1.44（0.18 - 2.70），1年以上至3年为0.94（0.36 - 1.53），3年以上至随访结束为2.17（1.14 - 3.21）。中位随访时间为2.13人年。
这项基于人群的研究表明，OAC主要在首次诊断为BO后的头几个月被诊断出来。这可能为改变BO的监测策略提供依据，即在首次诊断为BO后不久进行重复的全面内镜检查，以识别现有的早期OAC或HGD。
