Progression to cancer in patients with confirmed dysplasia compared to dysplasia downgraded to non-dysplastic metaplasia in Barrett's esophagus: a retrospective cohort study in Sweden.

IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Clinical Endoscopy Pub Date : 2024-11-01 Epub Date: 2024-11-25 DOI:10.5946/ce.2023.313
Peter Elbe, Åke Öst, Lennart Mellbom, Anders Thorell, Bengt Håkanson, Fredrik Klevebro, Mats Lindblad
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Abstract

Background/aims: This study aimed to clarify the risk of progression in patients with non-dysplastic Barrett's esophagus (NDBE) and patients with confirmed low-grade dysplasia (LGD) and indefinite for dysplasia (IND) after an expert pathologist review of patients with BE with suspected dysplasia in a prospective cohort.

Methods: Patients with Barrett's esophagus diagnosed with dysplasia at Ersta Hospital in Stockholm from 1998 to 2012 were included. The first dysplastic specimen in all patients was re-evaluated by two expert pathologists and classified as NDBE, LGD, IND, or cancer, including high-grade dysplasia. The incidence rates (IRs) and IR ratios were calculated with 95% confidence intervals.

Results: Of 423 patients with Barrett's esophagus with dysplasia, 266 (62.9%) were re-classified as NDBE, 83 (19.6%) had LGD, 71 (16.8%) had IND, and 3 (0.7%) patients had cancer. During the follow-up, 34 (8%) patients developed cancer, most of them within five years, while others progressed after up to 25 years of surveillance. IRs for cancer among patients with NDBE was 0.41%/year compared to 1.84%/year for LGD (p<0.001) and 1.43%/year for IND (p=0.008).

Conclusions: Long-term risk of progression to cancer did not differ between patients with confirmed LGD and IND. These findings suggest that patients with IND should undergo similar management as patients with LGD.

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在Barrett食管中,确诊为发育不良的患者与降级为非发育不良化生的患者相比进展为癌症:瑞典的一项回顾性队列研究。
背景/目的:本研究旨在通过专家病理学家对疑似发育不良的BE患者进行前瞻性队列检查,阐明非发育不良的巴雷特食管(NDBE)患者和确诊为低级别发育不良(LGD)和不确定发育不良(IND)患者的进展风险。方法:纳入1998 - 2012年在斯德哥尔摩Ersta医院诊断为Barrett食管发育不良的患者。所有患者的第一个发育不良标本由两位病理学专家重新评估,并分类为NDBE、LGD、IND或癌症,包括高度发育不良。发生率(IRs)和IR比值以95%置信区间计算。结果:423例Barrett食管伴不典型增生患者中,266例(62.9%)为NDBE, 83例(19.6%)为LGD, 71例(16.8%)为IND, 3例(0.7%)为肿瘤。在随访期间,34名(8%)患者发展为癌症,其中大多数在5年内,而其他患者在长达25年的监测后发展为癌症。NDBE患者的癌症风险为0.41%/年,而LGD患者为1.84%/年(结论:确诊的LGD和IND患者进展为癌症的长期风险没有差异。这些发现表明,IND患者应接受与LGD患者相似的管理。
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来源期刊
Clinical Endoscopy
Clinical Endoscopy GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
8.00%
发文量
95
审稿时长
26 weeks
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