Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma.
Esophageal Cancer
Long-Term Follow-Up
Outcome
Risk Factor
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
16
02
2018
revised:
01
07
2018
accepted:
04
07
2018
pubmed:
18
7
2018
medline:
30
7
2020
entrez:
18
7
2018
Statut:
ppublish
Résumé
European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P = .001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P < .001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18-0.57; P < .001). We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
Sections du résumé
BACKGROUND & AIMS
European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm).
METHODS
We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression.
RESULTS
We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P = .001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P < .001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18-0.57; P < .001).
CONCLUSION
We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
Identifiants
pubmed: 30012433
pii: S1542-3565(18)30708-0
doi: 10.1016/j.cgh.2018.07.008
pmc: PMC7050470
mid: NIHMS1563199
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
864-868Subventions
Organisme : NCI NIH HHS
ID : U54 CA163060
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Ann Intern Med. 2003 Feb 4;138(3):176-86
pubmed: 12558356
Aliment Pharmacol Ther. 2007 Dec;26(11-12):1465-77
pubmed: 17900269
Gut. 2015 Jun;64(6):864-71
pubmed: 25037191
Hum Pathol. 2001 Apr;32(4):368-78
pubmed: 11331953
Ann Intern Med. 2000 Apr 18;132(8):612-20
pubmed: 10766679
Am J Gastroenterol. 2016 Jan;111(1):30-50; quiz 51
pubmed: 26526079
Clin Gastroenterol Hepatol. 2013 Nov;11(11):1430-6
pubmed: 23707463
Gut. 2014 Jan;63(1):7-42
pubmed: 24165758
N Engl J Med. 2011 Oct 13;365(15):1375-83
pubmed: 21995385
Gastrointest Endosc. 2004 May;59(6):655-8
pubmed: 15114308
Hum Pathol. 1983 Nov;14(11):931-68
pubmed: 6629368
Am J Epidemiol. 2008 Aug 1;168(3):237-49
pubmed: 18550563
Gut. 2012 Jul;61(7):970-6
pubmed: 21997553
Gut. 2015 Dec;64(12):1874-80
pubmed: 25652086
J Natl Cancer Inst. 2011 Jul 6;103(13):1049-57
pubmed: 21680910
Gastroenterology. 2011 Mar;140(3):1084-91
pubmed: 21376940
Am J Gastroenterol. 2008 Mar;103(3):788-97
pubmed: 18341497
Gut. 2016 Feb;65(2):196-201
pubmed: 26113177