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.
Gastroenterology. 2022 Jul;163(1):285-294. doi: 10.1053/j.gastro.2022.03.020. Epub 2022 Mar 16.
BACKGROUND & AIMS: The combination of endoscopic resection and radiofrequency ablation is the treatment of choice for eradication of Barrett's esophagus (BE) with dysplasia and/or early cancer. Currently, there are no evidence-based recommendations on how to survey patients after successful treatment, and most patients undergo frequent follow-up endoscopies. We aimed to develop and externally validate a prediction model for visible dysplastic recurrence, which can be used to personalize surveillance after treatment.
We collected data from the Dutch Barrett Expert Center Registry, a nationwide registry that captures outcomes from all patients with BE undergoing endoscopic treatment in the Netherlands in a centralized care setting. We used predictors related to demographics, severity of reflux, histologic status at baseline, and treatment characteristics. We built a Fine and Gray survival model with least absolute shrinkage and selection operator penalization to predict the incidence of visible dysplastic recurrence after initial successful treatment. The model was validated externally in patients with BE treated in Switzerland and Belgium.
A total of 1154 patients with complete BE eradication were included for model building. During a mean endoscopic follow-up of 4 years, 38 patients developed recurrent disease (1.0%/person-year). The following characteristics were independently associated with recurrence (strongest to weakest predictor): a new visible lesion during treatment phase, higher number of endoscopic resection treatments, male sex, increasing BE length, high-grade dysplasia or cancer at baseline, and younger age. External validation showed a C-statistic of 0.91 (95% confidence interval, 0.86-0.94) with good calibration.
This is the first externally validated model to predict visible dysplastic recurrence after successful endoscopic eradication treatment of BE with dysplasia or early cancer. On external validation, our model has good discrimination and calibration. This model can help clinicians and patients to determine a personalized follow-up strategy.
内镜下切除联合射频消融术是治疗 Barrett 食管（BE）伴异型增生和/或早期癌症的首选方法。目前，对于成功治疗后如何进行患者随访，尚无循证医学推荐意见，大多数患者接受频繁的随访内镜检查。我们旨在开发并外部验证一种用于预测可见异型增生复发的预测模型，以便为治疗后监测提供个性化建议。
我们从荷兰 Barrett 专家中心注册中心收集数据，该注册中心是一个全国性的注册中心，在集中护理环境中捕获荷兰所有接受 BE 内镜治疗患者的结局。我们使用与人口统计学、反流严重程度、基线时的组织学状态以及治疗特征相关的预测因素。我们使用最小绝对收缩和选择算子惩罚法构建 Fine 和 Gray 生存模型，以预测初始成功治疗后可见异型增生复发的发生率。该模型在瑞士和比利时接受 BE 治疗的患者中进行了外部验证。
共有 1154 例 BE 完全消除的患者被纳入模型构建。在平均 4 年的内镜随访期间，有 38 例患者发生疾病复发（1.0%/人年）。与复发独立相关的特征（从最强预测因素到最弱预测因素）包括：治疗阶段出现新的可见病变、内镜下切除治疗次数增加、男性、BE 长度增加、基线时高级别异型增生或癌症、以及年龄较小。外部验证显示 C 统计量为 0.91（95%置信区间，0.86-0.94），具有良好的校准度。
这是首个经外部验证的预测 BE 伴异型增生或早期癌症经内镜成功消除治疗后可见异型增生复发的模型。在外部验证中，我们的模型具有良好的区分度和校准度。该模型可以帮助临床医生和患者确定个性化的随访策略。
