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. 2019 Apr 1;62(2):93-99.
doi: 10.1503/cjs.008716.

Predictors of dysplastic and neoplastic progression of Barrett’s esophagus

Saleh Alnasser  1 , Raman Agnihotram  1 , Myriam Martel  1 , Serge Mayrand  1 , Eduardo Franco  1 , Lorenzo Ferri  1
Affiliations

Predictors of dysplastic and neoplastic progression of Barrett’s esophagus

Saleh Alnasser et al. Can J Surg. .

Abstract
in English, French

Background: It is unknown why some cases of Barrett’s esophagus progress to invasive malignant disease rapidly while others do so more slowly or not at all. The aim of this study was to identify demographic and endoscopic factors that predict dysplastic and neoplastic progression in patients with Barrett’s esophagus.

Methods: Patients with Barrett’s esophagus who were assessed in 2000–2010 were assessed for inclusion in this retrospective study. Demographic and endoscopic variables were collected from an endoscopy database and the medical chart. Dysplastic and neoplastic progression was examined by time-to-event analysis. We used Cox proportional hazard regression modelling and generalized estimating equation methods to identify variables that were most predictive of neoplastic progression.

Results: A total of 518 patients had Barrett’s esophagus confirmed by endoscopy and pathology and at least 2 surveillance visits. Longer Barrett’s esophagus segment (≥ 3 cm) (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1–1.3) and increased age (≥ 60 yr) (OR 3.5, 95% CI 1.7–7.4) were independent predictors of progression from nondysplasia to dysplastic or neoplastic grades. Presence of mucosal irregularities (OR 8.6, 95% CI 2.4–30.4) and increased age (OR 5.1, 95% CI 1.6–16.6) were independent predictors of progression from nondysplasia to high-grade dysplasia or adenocarcinoma.

Conclusion: Increased age, longer Barrett’s segment and presence of mucosal irregularities were associated with increased risk of dysplastic and neoplastic progression. In addition to dysplasia, these factors may help stratify patients according to risk of neoplastic progression and be used to individualize surveillance. More prospective studies with larger samples are required to validate these results.

Contexte: On ignore pour quelle raison certains cas d’oesophage de Barrett évoluent rapidement vers une maladie maligne envahissante, tandis que d’autres progressent lentement ou se stabilisent. Le but de cette étude était d’identifier les facteurs démographiques et endoscopiques prédicteurs d’une progression dysplasique et néoplasique chez les patients porteurs d’un oesophage de Barrett.

Méthodes: Des patients présentant un oesophage de Barrett ayant été examinés entre 2000 et 2010, ont été évalués en vue de leur participation à cette étude rétrospective. Les variables démographiques et endoscopiques ont été recueillies à partir d’une base de données endoscopiques et des dossiers médicaux. La progression dysplasique et néoplasique a été évaluée par analyse du délai de survenue de l’événement. Nous avons utilisé le modèle de la régression de Cox (risques proportionnels) et les équations d’estimation généralisée afin d’identifier les variables les plus prédictives d’une progression néoplasique.

Résultats: En tout, 518 patients présentaient un oesophage de Barrett confirmé par examen endoscopique et anatomopathologique et comptaient au moins 2 visites de surveillance. La présence de segments d’oesophage de Barrett plus longs (≥ 3 cm) (rapport des cotes [RC] 1,2, intervalle de confiance à 95 % [IC] 1,1–1,3) et un âge avancé (≥ 60 ans) (RC 3,5, IC à 95 % 1,7–7,4) ont été des prédicteurs indépendants de progression d’un grade non dysplasique vers un grade dysplasique. La présence d’irrégularités muqueuses (RC 8,6, IC à 95 % 2,4–30,4) et l’âge avancé (RC 5,1, IC à 95 % 1,6–16,6) ont été des prédicteurs indépendants de progression de la non-dysplasie vers une dysplasie de haut grade ou l’adénocarcinome.

Conclusion: L’âge avancé, des segments d’oesophage de Barrett plus longs et la présence d’irrégularités muqueuses ont été associés à un risque accru de progression dysplasique et néoplasique. En plus de la dysplasie, ces facteurs peuvent faciliter la stratification des patients selon le risque de progression néoplasique et servir à individualiser la surveillance. Il faudra procéder à d’autres études prospectives auprès d’échantillons de population plus volumineux pour valider ces résultats.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Cumulative incidence of progression from nondysplastic Barrett’s esophagus to dysplastic or neoplastic grades by age. There was no difference between age groups (p = 0.1).
Fig. 2
Fig. 2
Cumulative incidence of progression from nondysplastic Barrett’s esophagus to dysplastic or neoplastic by length of Barrett’s esophagus segment. Longer length was a significant predictor of progression (p = 0.03).
Fig. 3
Fig. 3
Cumulative incidence of progression from nondysplastic Barrett’s esophagus to high-grade dysplasia or esophageal adenocarcinoma by age. There was no difference between age groups (p = 0.07).
Fig. 4
Fig. 4
Cumulative incidence of progression from nondysplastic Barrett’s esophagus to high-grade dysplasia or esophageal adenocarcinoma by presence of mucosal irregularities. Presence of mucosal irregularities was a significant predictor of progression (p = 0.001).
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