Factors predicting malignant progression in Barret’s oesophagus patients
Factors such as Barret’s oesophagus (BE) length, presence of low-grade dysplasia (LGD) and nodularity increase the risk of progression from nondysplastic (ND)BE or LGD to high-grade dysplasia (HGD) or oesophageal adenocarcinoma (EAC), a study has found.
The study included 318 NDBE patients and 301 BE-LGD patients (mean age, 62.6 years; 85 percent male). Those who developed HGD/EAC >12 months after the initial NDBE or LGD diagnosis were considered progressors.
During a mean follow-up of 5.3 years, seven NDBE and 21 LGD patients progressed to HGD/EAC.
In multivariate Cox proportional hazards models, progression was independently predicted by the following: BE length (hazards ratio [HR], 1.16; 95 percent CI, 1.03–1.29), baseline LGD (HR, 2.57; 1.13-6.57) and presence of nodularity (HR, 4.98; 1.80–11.7).
Of note, demographic (eg, age and sex) and lifestyle factors (eg, BMI and tobacco use) did not influence the risk of malignant progression. This is in line with reports from previous studies. [Ann Surg 2005;242:49-54; Am J Gastroenterol 2006;101:2187-2193; Gastroenterol Clin North Am 2015;44:299-315]
The predictive factors reported in the present study could help identify high-risk BE patients who would benefit from endoscopic therapy rather than surveillance, researchers said.
The study was limited by the inclusion of participants from tertiary referral centres, the small number of progressors in each patient group, and lack of data on alcohol and medication use.