Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study.
BACKGROUND
Reported incidence rates of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus (BO) vary widely. As the effectiveness of BO surveillance is crucially dependent on this rate, its clarification is essential.


METHODS
To estimate the rate of malignant progression in patients with BO, all patients with a first diagnosis of BO with no dysplasia (ND) or low-grade dysplasia (LGD) between 1991 and 2006 were identified in the Dutch nationwide registry of histopathology (PALGA). Follow-up data were evaluated up to November 2007.


RESULTS
42 207 patients with BO were included; 4132 (8%) of them had LGD. Re-evaluation endoscopies at least 6 months after initial diagnosis were performed in 16 365 patients (39%), who were significantly younger than those not re-examined (58+/-13 vs 63+/-16 years, p<0.001). These patients were followed-up for a total of 78 131 person-years, during which 666 (4%) high-grade dysplasia (HGD)/OACs occurred, affecting 4% of the surveillance patient population (mean age: 69+/-12 years, 76% male). After excluding HGD/OAC cases detected within 1 year after BO diagnosis (n=212, 32%), incidence rates per 1000 person-years were 4.3 (95% CI 3.4 to 5.5) for OAC and 5.8 (95% CI 4.6 to 7.0) for HGD/OAC combined. Risk factors for HGD/OAC were increased age (eg, >75 years HR 12; 95% CI 8.0 to 18), male sex (2.01; 1.68 to 2.60) and presence of LGD at baseline (1.91; 1.53 to 2.40).


CONCLUSIONS
In this largest reported cohort of unselected patients with BO, the annual risk of OAC was 0.4%. Male sex, older age and LGD at diagnosis are independent predictors of malignant progression, and should enable an improved risk assessment in BO.
de Jonge
Pieter J F
PJ
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. p.dejonge@erasmusmc.nl
van Blankenstein
Mark
M
Looman
Caspar W N
CW
Casparie
Mariël K
MK
Meijer
Gerrit A
GA
Kuipers
Ernst J
EJ
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D001706:Biopsy; D018450:Disease Progression; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology