TY - JOUR
T1 - Barrett's esophagus and adenocarcinoma risk
T2 - the experience of the North-Eastern Italian Registry (EBRA).
AU - Rugge, Massimo
AU - Zaninotto, Giovanni
AU - Parente, Paola
AU - Zanatta, Lisa
AU - Cavallin, Francesco
AU - Germanà, Bastianello
AU - Macrì, Ettore
AU - Galliani, Ermenegildo
AU - Iuzzolino, Paolo
AU - Ferrara, Francesco
AU - Marin, Renato
AU - Nisi, Emiliano
AU - Iaderosa, Gaetano
AU - Deboni, Michele
AU - Bellumat, Angelo
AU - Valiante, Flavio
AU - Florea, Georgeta
AU - Della Libera, Duilio
AU - Benini, Marco
AU - Bortesi, Laura
AU - Meggio, Alberto
AU - Zorzi, Maria G.
AU - Depretis, Giovanni
AU - Miori, Gianni
AU - Morelli, Luca
AU - Cataudella, Giovanni
AU - D'amore, Emanuele
AU - Franceschetti, Ilaria
AU - Bozzola, Loredana
AU - Paternello, Elisabetta
AU - Antonini, Cristina
AU - Di Mario, Francesco
AU - Dal Bò, Nadia
AU - Furlanetto, Alberto
AU - Norberto, Lorenzo
AU - Polese, Lino
AU - Iommarini, Silvia
AU - Farinati, Fabio
AU - Battaglia, Giorgio
AU - Diamantis, Giorgio
AU - Realdon, Stefano
AU - Guido, Ennio
AU - Mastropaolo, Gaetano
AU - Canova, Daniele
AU - Guerini, Antonello
AU - Franceschi, Marilisa
AU - Zirillo, Maurizio
PY - 2012/11
Y1 - 2012/11
N2 - To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression. HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.
AB - To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression. HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.
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M3 - Article
C2 - 23095623
AN - SCOPUS:84872021185
VL - 256
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 5
ER -