The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia: a multicenter cohort study
Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in...
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| Vydané v: | Gastrointestinal endoscopy Ročník 94; číslo 2; s. 263 - 270.e2 |
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| Hlavní autori: | , , , , , , , |
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| Jazyk: | English |
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United States
Elsevier Inc
01.08.2021
Mosby Yearbook |
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| ISSN: | 0016-5107, 1097-6779, 1097-6779 |
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| Abstract | Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND.
Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression.
Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016).
Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted. |
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| AbstractList | Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND.
Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression.
Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016).
Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted. Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND.BACKGROUND AND AIMSCurrent understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND.Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression.METHODSPatients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression.Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016).RESULTSFour hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016).Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted.CONCLUSIONPatients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted. |
| Author | Fitzgerald, Rebecca C. Pilonis, Nastazja D. Januszewicz, Wladyslaw Phillips, Richard di Pietro, Massimiliano O'Donovan, Maria Katzka, David A. Sawas, Tarek |
| Author_xml | – sequence: 1 givenname: Richard surname: Phillips fullname: Phillips, Richard organization: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom – sequence: 2 givenname: Wladyslaw orcidid: 0000-0002-8200-2661 surname: Januszewicz fullname: Januszewicz, Wladyslaw organization: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom – sequence: 3 givenname: Nastazja D. surname: Pilonis fullname: Pilonis, Nastazja D. organization: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom – sequence: 4 givenname: Maria surname: O'Donovan fullname: O'Donovan, Maria organization: Department of Histopathology, Addenbrooke's Hospital, Cambridge, United Kingdom – sequence: 5 givenname: Tarek surname: Sawas fullname: Sawas, Tarek organization: Mayo Clinic, Rochester, Minnesota, USA – sequence: 6 givenname: David A. surname: Katzka fullname: Katzka, David A. organization: Mayo Clinic, Rochester, Minnesota, USA – sequence: 7 givenname: Rebecca C. surname: Fitzgerald fullname: Fitzgerald, Rebecca C. organization: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom – sequence: 8 givenname: Massimiliano surname: di Pietro fullname: di Pietro, Massimiliano organization: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33548281$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2021 American Society for Gastrointestinal Endoscopy Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. 2021 by the American Society for Gastrointestinal Endoscopy. Published by Elsevier, Inc. 2021 American Society for Gastrointestinal Endoscopy |
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| Keywords | BE OR HGD SSBE CI EAC LGD PPI LSBE IQR FU BE-IND IMC |
| Language | English |
| License | This is an open access article under the CC BY license. Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
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| SubjectTerms | Adenocarcinoma - epidemiology Barrett Esophagus - epidemiology Cohort Studies Disease Progression Esophageal Neoplasms - epidemiology Humans Original Precancerous Conditions - epidemiology Retrospective Studies |
| Title | The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia: a multicenter cohort study |
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