Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan.
Department of Medical Oncology, Chiba University Hospital, Chiba, Japan.
Dig Dis Sci. 2021 Aug;66(8):2674-2681. doi: 10.1007/s10620-020-06563-1. Epub 2020 Aug 25.
BACKGROUND/AIM: Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma (EAC). Therefore, an accurate diagnosis of BE is important for the subsequent follow-up and early detection of EAC. However, the definitions of BE have not been standardized worldwide; columnar-lined epithelium (CLE) without intestinal metaplasia (IM) and/or < 1 cm is not diagnosed as BE in most countries. This study aimed to clarify the malignant potential of CLE without IM and/or < 1 cm genetically.
A total of 96 consecutive patients (including nine patients with EAC) who had CLE were examined. Biopsies for CLE were conducted, and patients were divided into those with IM and > 1 cm (Group A) and those without IM and/or < 1 cm (Group B). Malignant potential was assessed using immunochemical staining for p53. Moreover, causative genes were examined using next-generation sequencing (NGS) on ten patients without Helicobacter pylori infection and without atrophic gastritis.
Of the 96 patients, 66 were in Group B. The proportion of carcinoma/dysplasia in Group A was significantly higher than that in Group B (26.7% in Group A and 1.5% in Group B; p < 0.01). However, one EAC patient was found in Group B. In the immunostaining study for non-EAC patients, an abnormal expression of p53 was not observed in Group A, whereas p53 loss was observed in three patients (4.6%) in Group B. In the NGS study, a TP53 mutation was found in Group B.
CLE without IM and/or < 1 cm has malignant potential. This result suggests that patients with CLE as well as BE need follow-up.
背景/目的：巴雷特食管（BE）是食管腺癌（EAC）的前身。因此，准确诊断 BE 对于随后的 EAC 随访和早期检测非常重要。然而，BE 的定义在全球范围内尚未标准化；大多数国家不将无肠上皮化生（IM）和/或 < 1cm 的柱状上皮（CLE）诊断为 BE。本研究旨在从遗传学角度阐明无 IM 和/或 < 1cm 的 CLE 的恶性潜能。
共检查了 96 例连续患有 CLE 的患者（包括 9 例 EAC 患者）。对 CLE 进行活检，并将患者分为有 IM 和 > 1cm（A 组）和无 IM 和/或 < 1cm（B 组）。使用 p53 免疫化学染色评估恶性潜能。此外，对 10 例无幽门螺杆菌感染和无萎缩性胃炎的患者进行下一代测序（NGS）检查致病基因。
96 例患者中，66 例为 B 组。A 组的癌/异型增生比例明显高于 B 组（A 组为 26.7%，B 组为 1.5%；p<0.01）。然而，B 组中发现了 1 例 EAC 患者。在非 EAC 患者的免疫染色研究中，A 组未观察到 p53 异常表达，而 B 组 3 例患者（4.6%）观察到 p53 缺失。在 NGS 研究中，B 组发现了 TP53 突变。
无 IM 和/或 < 1cm 的 CLE 具有恶性潜能。这一结果表明，不仅患有 BE 的患者需要随访，而且患有 CLE 的患者也需要随访。
