title: Long-term follow-up of malignancy biomarkers in patients with Barrett's esophagus undergoing medical or surgical treatment.
abstract: OBJECTIVE
  This study aims to compare some validated biomarkers of malignancy (Ki-67, p53, and apoptosis) between 2 groups of patients with Barrett's esophagus (BE) undergoing randomly medical or surgical treatment.
  
  
  BACKGROUND
  The treatment of choice to prevent the malignant progression of BE remains controversial. Translational studies using biomarkers associated with the metaplasia-tumor pathway could be useful to provide some information in this regard.
  
  
  METHODS
  The study group consisted of 45 patients: 20 under medical treatment with 40 mg/day of proton pump inhibitors (PPIs) and 25 after Nissen fundoplication (NFP). After a median follow-up of 8 years (range, 5-10 years), the values of Ki-67, p53, and apoptosis were analyzed in all patients before treatment (n = 45) and then 1 year (n = 45), 3 years (n = 45), 5 years (n = 45), and 10 years (n = 25) afterwards in both groups of treatment. These values were also analyzed in 2 subgroups of patients with successful medical and surgical treatment.
  
  
  RESULTS
  Both Ki-67 and p53 remained stable after NFP, whereas they increased progressively in patients under PPIs with statistically significant differences between the 2 groups. Conversely, the apoptotic index increased progressively after NFP and decreased in the patients under PPIs with significant differences at 3, 5, and 10 years of follow-up. On comparing the subgroups of successful treatment the same differences were found.
  
  
  CONCLUSIONS
  Barrett's epithelium remains more stable after a long-term follow-up in patients with BE treated surgically than in those under PPIs even in the absence of abnormal rates of acid reflux.
authors.affiliation: Department of Surgery, Cancer Research Program, IMIM-Hospital del Mar, CIBERehd, Barcelona, Spain.
authors.forename: Luisa F
authors.initials: LF
authors.lastname: Martinez de Haro
authors.forename: Angeles
authors.initials: A
authors.lastname: Ortiz
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
authors.forename: Vicente
authors.initials: V
authors.lastname: Munitiz
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Martinez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Revilla
authors.forename: David
authors.initials: D
authors.lastname: Ruiz de Angulo
authors.forename: Juan
authors.initials: J
authors.lastname: Bermejo
authors.forename: Jose
authors.initials: J
authors.lastname: Yélamos
authors.forename: Joaquin
authors.initials: J
authors.lastname: Molina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017209:Apoptosis; D001471:Barrett Esophagus / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D054328:Proton Pump Inhibitors; D016159:Tumor Suppressor Protein p53