Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Clin Gastroenterol Hepatol. 2022 Nov;20(11):2495-2504.e5. doi: 10.1016/j.cgh.2022.02.057. Epub 2022 Mar 12.
BACKGROUND & AIMS: Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is safe and leads to complete eradication in the majority of patients. However, a subgroup will experience a more complex treatment course with a risk for failure or disease progression. Early identification of these patients may improve patient counseling and treatment outcomes. We aimed to develop a prognostic model for a complex treatment course.
We collected data from a nationwide registry that captures outcomes for all patients undergoing endoscopic eradication therapy for early BE neoplasia. A complex treatment course was defined as neoplastic progression, treatment failure, or the need for endoscopic resection during the radiofrequency ablation treatment phase. We developed a prognostic model using logistic regression. We externally validated our model in an independent registry.
A total of 1386 patients were included, of whom 78 (6%) had a complex treatment course. Our model identified patients with a BE length of 9 cm or longer with a visible lesion containing high-grade dysplasia/cancer, and patients with less than 50% squamous conversion after radiofrequency ablation were identified as high risk for a complex treatment. This applied to 8% of the study population and included 93% of all treatment failures and 76% of all patients with advanced neoplastic progression. The model appeared robust in multiple sensitivity analyses and performed well in external validation (area under the curve, 0.84).
We developed a prognostic model that identified patients with a BE length of 9 cm or longer and high-grade dysplasia/esophageal adenocarcinoma and those with poor squamous regeneration as high risk for a complex treatment course. The good performance in external validation suggests that it may be used in clinical management (Netherlands Trial Register: NL7039).
内镜下消除 Barrett 食管（BE）相关肿瘤的治疗是安全的，可使大多数患者达到完全消除。然而，有一部分患者的治疗过程较为复杂，有治疗失败或疾病进展的风险。早期识别这些患者可能有助于改善患者咨询和治疗结果。本研究旨在开发一种用于预测复杂治疗过程的预后模型。
我们从一个全国性的登记处收集了所有接受早期 BE 肿瘤内镜下消除治疗的患者的数据。复杂的治疗过程定义为肿瘤进展、治疗失败或射频消融治疗期间需要内镜切除。我们使用逻辑回归开发了一个预后模型，并在独立的登记处进行了外部验证。
共纳入 1386 例患者，其中 78 例（6%）有复杂的治疗过程。我们的模型确定了 BE 长度为 9cm 或更长、有可见病变且含有高级别异型增生/癌症的患者，以及射频消融后鳞状上皮转化不足 50%的患者为复杂治疗的高危患者。这适用于研究人群的 8%，包括 93%的治疗失败患者和 76%的高级别肿瘤进展患者。该模型在多项敏感性分析中表现稳健，在外部验证中表现良好（曲线下面积为 0.84）。
我们开发了一种预后模型，该模型可识别出 BE 长度为 9cm 或更长、高级别异型增生/食管腺癌以及鳞状上皮再生不良的患者，这些患者的复杂治疗过程风险较高。在外部验证中的良好表现表明，它可能在临床管理中使用（荷兰临床试验注册中心：NL7039）。
