Honing Judith, Tan W Keith, Lu Victor Yan Zhe, Gourgiotis Vlasios, Gianfrancesco Isaac M, Schumacher Alina A, Vishwanathan Shriya, Cheah Calvin, Modolell Ines, Sujendran Vijay, Fitzgerald Rebecca C, di Pietro Massimiliano
Early Cancer Institute, University of Cambridge, Cambridge, UK.
Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
United European Gastroenterol J. 2025 Mar;13(2):220-228. doi: 10.1002/ueg2.12759. Epub 2025 Feb 13.
INTRODUCTION: Specialist guidelines recommend endoscopic surveillance for Barrett's esophagus to reduce mortality related to esophageal adenocarcinoma, but the setting for optimal Barrett's esophagus monitoring is unclear. We assessed progression rate and disease-specific mortality in a large cohort of patients followed up at a single Barrett's esophagus expert center. METHODS: For this prospective longitudinal single center cohort study, we recruited patients with a previous diagnosis of Barrett's esophagus between 2004 and 2022. Endoscopists were trained in Barrett's esophagus surveillance standards and image-enhanced techniques, and biopsies were reviewed by expert pathologists. Exclusion criteria were a single surveillance endoscopy, high-grade dysplasia, or esophageal adenocarcinoma at or within 12 months from index endoscopy and patients with < 12 months follow-up. The primary outcome was the neoplastic progression rate of Barrett's esophagus with intestinal metaplasia to high-grade dysplasia/esophageal adenocarcinoma. Secondary outcomes included cancer stage and disease-specific mortality, risk factors for progression and progression rate in patients with Barrett's esophagus with only gastric metaplasia or irregular z-line and intestinal metaplasia (IZL-IM). RESULTS: A total of 1932 patients were recruited, of which 969 were included in the primary analysis with a median follow-up of 5.8 years. Of these, 109 developed high-grade dysplasia or esophageal adenocarcinoma with a progression rate of 1.63%/year. Overall, 48 patients received an esophageal adenocarcinoma diagnosis, of which 89,5% (43/48) had stage 1%, and 0.3% patients (3/969) had disease-specific mortality. Multivariate analysis showed that age, alcohol consumption, esophagitis, Barrett's esophagus length, hiatus hernia length, low-grade dysplasia and neutrophil/lymphocyte ratio were risk factors for progression. The rate of progression in patients with Barrett's esophagus-gastric metaplasia or IZL-IM was 0.06%/year. CONCLUSIONS: Endoscopic surveillance in an expert Barrett's esophagus center leads to a high neoplastic progression rate, and a low rate of disease-specific mortality. Further research to correlate disease-specific mortality and cancer stage with dysplasia detection rate is warranted to develop diagnostic quality indicators specific for Barrett's esophagus.
引言：专家指南推荐对巴雷特食管进行内镜监测，以降低与食管腺癌相关的死亡率，但最佳巴雷特食管监测的环境尚不清楚。我们评估了在一个巴雷特食管专家中心随访的一大群患者的进展率和疾病特异性死亡率。 方法：在这项前瞻性纵向单中心队列研究中，我们招募了2004年至2022年间先前诊断为巴雷特食管的患者。内镜医师接受了巴雷特食管监测标准和图像增强技术的培训，活检由专家病理学家进行审查。排除标准为单次监测内镜检查、高级别异型增生、或在索引内镜检查时或之后12个月内发生食管腺癌，以及随访时间<12个月的患者。主要结局是伴有肠化生的巴雷特食管进展为高级别异型增生/食管腺癌的肿瘤进展率。次要结局包括癌症分期和疾病特异性死亡率、仅伴有胃化生或不规则Z线及肠化生（IZL-IM）的巴雷特食管患者的进展危险因素和进展率。 结果：共招募了1932例患者，其中969例纳入主要分析，中位随访时间为5.8年。其中，109例发生高级别异型增生或食管腺癌，进展率为1.63%/年。总体而言，48例患者被诊断为食管腺癌，其中89.5%（43/48）为1期，0.3%的患者（3/969）有疾病特异性死亡。多因素分析显示，年龄、饮酒、食管炎、巴雷特食管长度、食管裂孔疝长度、低级别异型增生和中性粒细胞/淋巴细胞比值是进展的危险因素。巴雷特食管-胃化生或IZL-IM患者的进展率为0.06%/年。 结论：在巴雷特食管专家中心进行内镜监测导致较高的肿瘤进展率和较低的疾病特异性死亡率。有必要进一步研究将疾病特异性死亡率和癌症分期与异型增生检出率相关联，以制定巴雷特食管的诊断质量指标。
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