Abstract:
:Barrett's esophagus is a well-recognized risk factor for esophageal adenocarcinoma. The natural history of Barrett's esophagus classified as ‘indefinite for dysplasia’ (IND) is poorly characterized. The aim of this study is to characterize the natural history of IND by determining the rate of neoplastic progression and identifying risk factors for progression. Patients from the University of Pennsylvania Health System pathology database and Barrett's esophagus registry with a diagnosis of IND between 2000 and 2014 were identified. Exclusion criteria included: (1) prior diagnosis of low-grade dysplasia (LGD), high-grade dysplasia (HGD), or esophageal adenocarcinoma (EAC); (2) presence of LGD, HGD, or EAC at the time of diagnosis of IND; and (3) lack of follow-up endoscopy after diagnosis. Patients with neoplastic progression were classified as having either prevalent disease (LGD, HGD, or EAC on surveillance biopsy within 12 months of IND diagnosis) or incident disease (LGD, HGD, or EAC on surveillance biopsy >12 months after IND diagnosis). One hundred six patients were eligible for analysis. Of 87 patients with follow-up endoscopy and biopsies within 1 year of IND diagnosis, 7 (8%) had prevalent disease (2 LGD, 4 HGD, 1 EAC). The prevalence of LGD was 2.3%, HGD was 4.6%, and EAC was 1.1%. Importantly, four of the seven prevalent (2 LGD, 2 HGD) cases were found to have dysplasia within 6 months of IND diagnosis. No demographic or endoscopic characteristics studied were associated with prevalent disease. Of the 106 IND patients, there were 66 patients without prevalent dysplasia with >1-year follow-up. Three (4.5%) progressed (1 to LGD after 12 months, 2 to HGD after 16.5 and 28 months), yielding an incidence rate for any dysplasia of 1.4 cases/100 person-years and HGD/EAC of 0.9/100 person-years. Risk factors for incident disease were smoking (p = 0.02) and Barrett's esophagus segment length (p = 0.03). IND is associated with considerable risk of prevalent dysplasia, especially within the first 6 months after diagnosis. However, the incidence of HGD/EAC is low and similar to previous studies of IND. These data suggest that IND patients should have repeat endoscopy within 6 months with careful surveillance protocols. Longer BE length and smoking history may help predict which patients are more likely to develop dysplasia, and therefore identify patients who may warrant even closer monitoring.
journal_name
Dis Esophagusjournal_title
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagusauthors
Ma M,Shroff S,Feldman M,DeMarshall M,Price C,Tierney A,Falk GWdoi
10.1093/dote/dow025subject
Has Abstractpub_date
2017-03-01 00:00:00pages
1-5issue
3eissn
1120-8694issn
1442-2050pii
2981986journal_volume
30pub_type
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 临床试验,杂志文章
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pub_type: 临床试验,杂志文章
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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abstract:BACKGROUND:The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular s...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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更新日期:2020-09-04 00:00:00