daw
10-05-2004, 03:36 PM
From The American Journal of Gastroenterology
Risk Stratification of Barrett's Esophagus: Updated Prospective Multivariate Analysis
Posted 09/29/2004
Allan P. Weston, M.D.; Prateek Sharma, M.D.; Sharad Mathur, M.D.; Sushanta Banerjee, Ph.D.; A. Khatib Jafri, M.D.; Rachel Cherian, M.D.; Douglas McGregor, M.D.; Ruth S. Hassanein, Ph.D.; Matthew Hall, Ph.D.
Abstract and Introduction
Abstract
Objectives: Prospective evaluation of Barrett's esophagus (BE) in order to determine what demographic, endoscopic, and histologic features are predictive of the prevalence and incidence of Barrett's high-grade dysplasia (HGD) and adenocarcinoma (Ca).
Methods: Newly diagnosed BE patients were entered into and followed in a standardized surveillance protocol. The following features were examined using either forward, stepwise multiple regression analysis, or Cox proportional hazards to determine their ability to predict the presence of HGD or Ca at index BE diagnosis as well as their ability to predict progression of BE during follow-up: age, race, gender, length of BE in cm, size of a hiatal hernia, severity of dysplasia at index diagnosis as well as during surveillance, gastric Helicobacter pylori infection status, and type of medical acid-reflux treatment.
Results: A total of 550 patients were diagnosed with BE over the study period. Stepwise multiple regression analysis showed three factors significantly associated with index diagnosis of HGD or Ca: hiatal hernia (larger size), Barrett's length (longer length), and absence of H. pylori infection. Three hundred and twenty-four BE entered the surveillance protocol. Cox proportional hazards models revealed a significant and independent association for five factors predictive of the time to progression of BE: presence of dysplasia at index diagnosis (p < 0.001), severity of dysplasia during surveillance (p < 0.001), length of Barrett's epithelium (p = 0.012), size of hiatal hernia (p = 0.006), and gastric H. pylori infection status (p = 0.023).
Conclusions: Endoscopic and histologic features of BE at initial diagnosis are predictive of index HGD and cancer as well as with risk of BE progression.
Introduction
Barrett's esophagus (BE) is a precursor of esophageal and gastroesophageal junction (GEJ) adenocarcinoma (Ca).[1,2] Because Barrett's is a premalignant condition, endoscopic biopsy surveillance is recommended for all Barrett's patients in order to detect either high-grade dysplasia (HGD) or Ca at an early, curable stage.[3-5] However, the vast majority of Barrett's patients do not undergo malignant progression, but instead die from unrelated diseases.[6-8] Risk stratification of Barrett's esophagus (BE) has been elegantly delineated using certain molecular features including 17p LOH,[9-11] 9p LOH[10,12] and p16 mutations.[13] Furthermore, dual-parameter flow cytometry of Barrett's has proven to be of prognostic value with patients exhibiting aneuploidy and/or increased G2/tetraploid fractions exhibiting an increased risk of progression to cancer.[14-18] However, the majority of Barrett's surveillance endoscopic examinations are performed by centers that do not have molecular typing or flow cytometry methods available to risk-stratify BE. Identification of simple, easily attainable, clinical, endoscopic, and histologic features that could accurately predict the development of Barrett's Ca (i.e., risk stratification) and hence provide a guide for the timing of surveillance examinations, would have practical utility to all endoscopists.
We previously reported on the results of a prospective study of a cohort of Barrett's patients[19] that revealed several features of Barrett's at index diagnosis that were predictive of the development of Barrett's Ca or multifocal HGD: namely, length of Barrett's, hiatal hernia, and presence of dysplasia at index diagnosis and during follow-up. However, cohort size and clustering together of HGD and cancer raised concerns. Furthermore, we also reported on the protective effect of H. pylori infection on the prevalence of Barrett's HGD and cancer compared to BE without dysplasia and GERD.[20] The report detailed herein is an update of these ongoing prospective studies of BE with the goal of developing a simple system to risk-stratify BE at index diagnosis.
complete article: http://www.medscape.com/viewarticle/489429?src=mp
Risk Stratification of Barrett's Esophagus: Updated Prospective Multivariate Analysis
Posted 09/29/2004
Allan P. Weston, M.D.; Prateek Sharma, M.D.; Sharad Mathur, M.D.; Sushanta Banerjee, Ph.D.; A. Khatib Jafri, M.D.; Rachel Cherian, M.D.; Douglas McGregor, M.D.; Ruth S. Hassanein, Ph.D.; Matthew Hall, Ph.D.
Abstract and Introduction
Abstract
Objectives: Prospective evaluation of Barrett's esophagus (BE) in order to determine what demographic, endoscopic, and histologic features are predictive of the prevalence and incidence of Barrett's high-grade dysplasia (HGD) and adenocarcinoma (Ca).
Methods: Newly diagnosed BE patients were entered into and followed in a standardized surveillance protocol. The following features were examined using either forward, stepwise multiple regression analysis, or Cox proportional hazards to determine their ability to predict the presence of HGD or Ca at index BE diagnosis as well as their ability to predict progression of BE during follow-up: age, race, gender, length of BE in cm, size of a hiatal hernia, severity of dysplasia at index diagnosis as well as during surveillance, gastric Helicobacter pylori infection status, and type of medical acid-reflux treatment.
Results: A total of 550 patients were diagnosed with BE over the study period. Stepwise multiple regression analysis showed three factors significantly associated with index diagnosis of HGD or Ca: hiatal hernia (larger size), Barrett's length (longer length), and absence of H. pylori infection. Three hundred and twenty-four BE entered the surveillance protocol. Cox proportional hazards models revealed a significant and independent association for five factors predictive of the time to progression of BE: presence of dysplasia at index diagnosis (p < 0.001), severity of dysplasia during surveillance (p < 0.001), length of Barrett's epithelium (p = 0.012), size of hiatal hernia (p = 0.006), and gastric H. pylori infection status (p = 0.023).
Conclusions: Endoscopic and histologic features of BE at initial diagnosis are predictive of index HGD and cancer as well as with risk of BE progression.
Introduction
Barrett's esophagus (BE) is a precursor of esophageal and gastroesophageal junction (GEJ) adenocarcinoma (Ca).[1,2] Because Barrett's is a premalignant condition, endoscopic biopsy surveillance is recommended for all Barrett's patients in order to detect either high-grade dysplasia (HGD) or Ca at an early, curable stage.[3-5] However, the vast majority of Barrett's patients do not undergo malignant progression, but instead die from unrelated diseases.[6-8] Risk stratification of Barrett's esophagus (BE) has been elegantly delineated using certain molecular features including 17p LOH,[9-11] 9p LOH[10,12] and p16 mutations.[13] Furthermore, dual-parameter flow cytometry of Barrett's has proven to be of prognostic value with patients exhibiting aneuploidy and/or increased G2/tetraploid fractions exhibiting an increased risk of progression to cancer.[14-18] However, the majority of Barrett's surveillance endoscopic examinations are performed by centers that do not have molecular typing or flow cytometry methods available to risk-stratify BE. Identification of simple, easily attainable, clinical, endoscopic, and histologic features that could accurately predict the development of Barrett's Ca (i.e., risk stratification) and hence provide a guide for the timing of surveillance examinations, would have practical utility to all endoscopists.
We previously reported on the results of a prospective study of a cohort of Barrett's patients[19] that revealed several features of Barrett's at index diagnosis that were predictive of the development of Barrett's Ca or multifocal HGD: namely, length of Barrett's, hiatal hernia, and presence of dysplasia at index diagnosis and during follow-up. However, cohort size and clustering together of HGD and cancer raised concerns. Furthermore, we also reported on the protective effect of H. pylori infection on the prevalence of Barrett's HGD and cancer compared to BE without dysplasia and GERD.[20] The report detailed herein is an update of these ongoing prospective studies of BE with the goal of developing a simple system to risk-stratify BE at index diagnosis.
complete article: http://www.medscape.com/viewarticle/489429?src=mp