Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Norra Stationsgatan 67, Solna (L1:00), 171 76, Stockholm, Sweden.
Department of Public Health and Nursing, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Forskningsvegen 2, 7600, Levanger, Norway.
Surg Endosc. 2019 Sep;33(9):2901-2908. doi: 10.1007/s00464-018-6590-5. Epub 2018 Nov 19.
Individuals with Barrett's esophagus (BE) are at increased risk of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC), but the cost-effectiveness of general surveillance of BE is low. This study aimed to identify a risk prediction model for tumor progression in individuals with BE based on age, sex, and risk factors found at upper endoscopy, enabling tailored surveillance.
This nested case-control study originated from a cohort of 8171 adults diagnosed with BE in 2006-2013 in the Swedish Patient Registry. Cases had EAC/HGD (n = 279) as identified from the Swedish Cancer Registry, whereas controls had no EAC/HGD (n = 1089). Findings from endoscopy and histopathology reports were extracted from medical records at 71 Swedish hospitals and from the Swedish Patient Registry. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CIs).
Older age (OR 1.02 [95% CI 1.01-1.03] per year), male sex (OR 2.8 [95% CI 1.9-4.1]), and increasing maximum BE length (OR 2.3 [95% CI 1.4-3.9] for segments 3-8 cm and OR 4.3 [95% CI 2.5-7.2] for segments ≥ 8 cm) increased the risk of EAC/HGD, while the circumferential extent of the BE, hiatal hernia or reflux esophagitis did not. A model based on age, sex, and maximum BE length predicted 71% of all EAC/HGD cases.
A simple combination of the variables age, sex and maximum BE length showed fairly good accuracy for predicting tumor progression in BE. This clinical risk prediction model may help to tailor future surveillance programs.
巴雷特食管（BE）患者发生高级别异型增生（HGD）和食管腺癌（EAC）的风险增加，但 BE 的常规监测的成本效益较低。本研究旨在根据内镜检查中发现的年龄、性别和危险因素，为 BE 患者建立肿瘤进展的风险预测模型，从而实现个体化监测。
本巢式病例对照研究源于 2006-2013 年在瑞典患者登记处诊断为 BE 的 8171 名成年人队列。病例组（n=279）由瑞典癌症登记处确定为 EAC/HGD，而对照组（n=1089）未患有 EAC/HGD。在 71 家瑞典医院的医疗记录和瑞典患者登记处提取内镜和组织病理学报告的结果。多变量逻辑回归提供了比值比（OR）及其 95%置信区间（CI）。
年龄较大（每年增加 1.02 [95%CI 1.01-1.03]）、男性（OR 2.8 [95%CI 1.9-4.1]）和最大 BE 长度增加（长度为 3-8 cm 时增加 2.3 [95%CI 1.4-3.9]，长度≥8 cm 时增加 4.3 [95%CI 2.5-7.2]）会增加 EAC/HGD 的风险，而 BE 的环周程度、食管裂孔疝或反流性食管炎则不会。基于年龄、性别和最大 BE 长度的模型预测了所有 EAC/HGD 病例的 71%。
年龄、性别和最大 BE 长度的简单组合对预测 BE 中的肿瘤进展具有相当高的准确性。这种临床风险预测模型可能有助于定制未来的监测计划。
