TY - JOUR
T1 - Risk stratification of patients with barrett's esophagus andlow-grade dysplasia or indefinite for dysplasia
AU - Thota, Prashanthi N.
AU - Lee, Hyun Ju
AU - Goldblum, John R.
AU - Liu, Xiuli
AU - Sanaka, Madhusudhan R.
AU - Gohel, Tushar
AU - Kanadiya, Mehulkumar
AU - Lopez, Rocio
N1 - Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background & Aims: In patients with Barrett's esophagus (BE), low-grade dysplasia (LGD) is a risk factor for esophageal adenocarcinoma (EAC), progressing at variable rates. Patients at higher risk forprogression could benefit from intervention. We assessed rates of progression of LGD and indefinite for dysplasia (IND) and risk factors for progression to high-grade dysplasia (HGD) and EAC. Methods: We analyzed data from Cleveland Clinic Barrett's Registry on patients with BE and LGD or INDat least 1 year of follow-up from January 1, 2002 through December 31, 2012. Prevalent cases were those diagnosed at or within 1 year of the first endoscopy, and the rest were incident cases. Results: Among 299 patients with BE and LGD or IND, there were 32 cases of HGD and 10 cases of EAC during a follow-up period of 1577.4 patient-years. The annual incidence rates were 2.4% (95% confidence interval [CI], 1.7%-3.3%) for HGD, 0.6% (95% CI, 0.3%-1.2%) for EAC, and 2.7% (95% CI, 1.9%-3.6%) for HGD or EAC. The rates were higher in men than in women with BE and LGD or IND. Prevalent cases were 3-fold more likely to progress than incident cases. Multifocality and nodules were associated with higher risk of progression to HGD or EAC. None of the patients with IND at index biopsy developed EAC. For every 5-year increase in age, chance of regression increased by 7% (P = .04). Also, for every 1-cm increase in BE length, probability of regression decreased by 6% (P = .016). LGD at index biopsy was associated with 56% lower chance of regression compared with IND (P < .001). Conclusions: On the basis of a database analysis of patients with BE, prevalent LGD, male sex, multifocality, and nodules were associated with higher risk for progression to EAC. Older age at LGD diagnosis, IND at index biopsy, and shorter BE length were associated with regression. These findings help in risk stratification of patients with BE and LGD or IND.
AB - Background & Aims: In patients with Barrett's esophagus (BE), low-grade dysplasia (LGD) is a risk factor for esophageal adenocarcinoma (EAC), progressing at variable rates. Patients at higher risk forprogression could benefit from intervention. We assessed rates of progression of LGD and indefinite for dysplasia (IND) and risk factors for progression to high-grade dysplasia (HGD) and EAC. Methods: We analyzed data from Cleveland Clinic Barrett's Registry on patients with BE and LGD or INDat least 1 year of follow-up from January 1, 2002 through December 31, 2012. Prevalent cases were those diagnosed at or within 1 year of the first endoscopy, and the rest were incident cases. Results: Among 299 patients with BE and LGD or IND, there were 32 cases of HGD and 10 cases of EAC during a follow-up period of 1577.4 patient-years. The annual incidence rates were 2.4% (95% confidence interval [CI], 1.7%-3.3%) for HGD, 0.6% (95% CI, 0.3%-1.2%) for EAC, and 2.7% (95% CI, 1.9%-3.6%) for HGD or EAC. The rates were higher in men than in women with BE and LGD or IND. Prevalent cases were 3-fold more likely to progress than incident cases. Multifocality and nodules were associated with higher risk of progression to HGD or EAC. None of the patients with IND at index biopsy developed EAC. For every 5-year increase in age, chance of regression increased by 7% (P = .04). Also, for every 1-cm increase in BE length, probability of regression decreased by 6% (P = .016). LGD at index biopsy was associated with 56% lower chance of regression compared with IND (P < .001). Conclusions: On the basis of a database analysis of patients with BE, prevalent LGD, male sex, multifocality, and nodules were associated with higher risk for progression to EAC. Older age at LGD diagnosis, IND at index biopsy, and shorter BE length were associated with regression. These findings help in risk stratification of patients with BE and LGD or IND.
KW - Carcinogenesis
KW - Esophageal cancer
KW - Patient management
KW - Tumor
UR - http://www.scopus.com/inward/record.url?scp=84925374781&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2014.07.049
DO - 10.1016/j.cgh.2014.07.049
M3 - Article
C2 - 25102445
AN - SCOPUS:84925374781
SN - 1542-3565
VL - 13
SP - 459-465.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -