Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data.

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical Gastroenterology and Hepatology Pub Date : 2024-10-05 DOI:10.1016/j.cgh.2024.06.053

Pauline A Zellenrath, Laurelle van Tilburg, Roos E Pouw, Rena Yadlapati, Yonne Peters, Michael B Ujiki, Prashanthi N Thota, Norihisa Ishimura, Stephen J Meltzer, Noam Peleg, Won-Tak Choi, John V Reynolds, Alexandros D Polydorides, Arjun D Koch, Judith Honing, Manon C W Spaander

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Abstract

Background and aims: Females with Barrett's esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.

Methods: We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.

Results: IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13-1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1-7.7 years) in females and 4.2 years (interquartile range, 2.0-8.1 years) in males.

Conclusion: Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.

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女性巴雷特食管癌患者的肿瘤进展风险：对患者个体数据的系统回顾和荟萃分析。

背景和目的：女性巴雷特食管（Barrett's esophagus，BE）患者的肿瘤进展风险低于男性，但目前缺乏足够的风险分析。本研究对患者个体数据（IPD）进行系统回顾和荟萃分析，旨在为女性肿瘤进展风险提供更有力的证据：对三个电子数据库（Medline、Embase、Google Scholar）进行系统文献检索，检索时间从开始到 2023 年 8 月。符合条件的研究(1)报告了从非增生异常BE（NDBE）、增生异常不定期（IND）或低度增生异常（LGD）到高级别增生异常（HGD）或食管腺癌（EAC）进展的原始数据，(2)纳入了女性和男性患者。IPD由两名独立审稿人进行质量控制。主要结果是性别与肿瘤进展风险之间的关系，使用多变量考克斯回归分析对风险因素进行调整。次要结果是进展时间和年进展率的性别差异：从11/66项符合条件的研究中获得了IPD，其中包括2 196名女性（31%）。在对年龄、吸烟、用药、食道裂孔疝、BE长度和基线病理学进行调整后，女性的肿瘤进展风险较低（男性与女性的HR为1.44，95%CI为1.13-1.82）。女性的年进展率为 0.88%，男性为 1.29%。男女肿瘤进展时间相似：女性为3.7年（IQR 2.1-7.7），男性为4.2年（IQR 2.0-8.1）：结论：虽然女性肿瘤恶化的风险较低，但性别差异小于之前的报道，而且男女肿瘤恶化的时间相似。未来的研究应关注性别以外的其他因素，以识别低风险和高风险的 BE 患者。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.