From the Department of General Surgery, McGill University Health Centre, Montreal, Que. (Alnasser); the Department of Epidemiology and Biostatistics – Cancer Epidemiology, McGill University, Montreal, Que. (Agnihotram, Franco); and the Ringgold Standard Institution – Gastroenterology, McGill University Health Centre, Montréal, Que. (Martel, Mayrand, Ferri).
Can J Surg. 2019 Apr 1;62(2):93-99. doi: 10.1503/cjs.008716.
It is unknown why some cases of Barrett’s esophagus progress to invasive malignant disease rapidly while others do so more slowly or not at all. The aim of this study was to identify demographic and endoscopic factors that predict dysplastic and neoplastic progression in patients with Barrett’s esophagus.
Patients with Barrett’s esophagus who were assessed in 2000–2010 were assessed for inclusion in this retrospective study. Demographic and endoscopic variables were collected from an endoscopy database and the medical chart. Dysplastic and neoplastic progression was examined by time-to-event analysis. We used Cox proportional hazard regression modelling and generalized estimating equation methods to identify variables that were most predictive of neoplastic progression.
A total of 518 patients had Barrett’s esophagus confirmed by endoscopy and pathology and at least 2 surveillance visits. Longer Barrett’s esophagus segment (≥ 3 cm) (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1–1.3) and increased age (≥ 60 yr) (OR 3.5, 95% CI 1.7–7.4) were independent predictors of progression from nondysplasia to dysplastic or neoplastic grades. Presence of mucosal irregularities (OR 8.6, 95% CI 2.4–30.4) and increased age (OR 5.1, 95% CI 1.6–16.6) were independent predictors of progression from nondysplasia to high-grade dysplasia or adenocarcinoma.
Increased age, longer Barrett’s segment and presence of mucosal irregularities were associated with increased risk of dysplastic and neoplastic progression. In addition to dysplasia, these factors may help stratify patients according to risk of neoplastic progression and be used to individualize surveillance. More prospective studies with larger samples are required to validate these results.
目前尚不清楚为什么有些巴雷特食管病例会迅速进展为侵袭性恶性疾病，而有些则进展缓慢或根本不会进展。本研究旨在确定预测巴雷特食管患者发生异型增生和肿瘤进展的人口统计学和内镜因素。
对 2000 年至 2010 年进行评估的巴雷特食管患者进行了回顾性研究。从内镜数据库和病历中收集了人口统计学和内镜变量。通过生存时间分析来评估异型增生和肿瘤进展。我们使用 Cox 比例风险回归模型和广义估计方程方法来确定最能预测肿瘤进展的变量。
共有 518 例患者经内镜和病理检查证实存在巴雷特食管，并至少进行了 2 次监测。较长的巴雷特食管段（≥3cm）（比值比[OR]1.2，95%置信区间[CI]1.1-1.3）和年龄较大（≥60 岁）（OR 3.5，95%CI 1.7-7.4）是从非异型增生进展为异型增生或肿瘤级别的独立预测因素。黏膜不规则（OR 8.6，95%CI 2.4-30.4）和年龄较大（OR 5.1，95%CI 1.6-16.6）是从非异型增生进展为高级别异型增生或腺癌的独立预测因素。
年龄较大、巴雷特食管段较长和黏膜不规则与异型增生和肿瘤进展的风险增加相关。除了异型增生，这些因素可能有助于根据肿瘤进展的风险对患者进行分层，并用于个体化监测。需要进行更多的前瞻性研究，以验证这些结果。
