title: A 5.5-year surveillance of esophageal and gastric cardia precursors after a population-based screening in China.
abstract: OBJECTIVE
  This study aimed to estimate the time to precursor progression and to identify significant predicators.
  
  
  METHODS
  One hundred thirty-three precursor and 311 normal cases detected in a population-based screening were surveyed for 5.5 years. Precursor progression was defined as worsening of dysplasia or development of a new precursor. Time to precursor progression was estimated by the Kaplan-Meier method. Significant predicators were estimated by Cox proportional regression.
  
  
  RESULTS
  Of the 133 precursor cases, 33.08% (44/133) progressed or recurred, 30.08% (40/133) persisted, and 36.84% (49/133) regressed; of the 311 normal subjects, 13.50% (42/311) developed a precursor. Progression occurred significantly earlier and more frequently with ncreasing histology: with mind dysplasia (mD), 7.8% progressed by 1 year and 23.3% progressed by 5 year; with moderate dysplasia (MD), 18% progressed by 1 year and 70% progressed by 5 years; and with severe dysplasia, 50% progressed by 1 year and 100% progressed by 5 years. The difference between any two groups was significant. In addition, the marginal Lugol-stained mucosa at endoscopic mucosal resection had a progressing risk similar to that of MD, and basal cell hyperplasia was similar to that of mD. Significant predicators for precursor progression included male sex (hazard ratio and 95% CI: 2.74 (1.63-4.60)), age over 50 years (2.31 (1.33-4.02)), family history of upper gastrointestinal cancer (UGIC) (1.56 (1.00-2.45)), multifocal dysplasia (5.11 (3.01-8.68)), and baseline histology.
  
  
  CONCLUSIONS
  Sex, age, family history of UGIC, multifocal dysplasia, and baseline histology are significant independent predicators for precursor progression. Patients after endoscopic mucosal resection should be continuously surveyed.
authors.affiliation: Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Denggui
authors.initials: D
authors.lastname: Wen
authors.affiliation: Department of Endoscope, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Liwei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Endoscope, Shexian Cancer Institute, Shexian, China.
authors.forename: Yongwei
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Endoscope, Shexian Cancer Institute, Shexian, China.
authors.forename: Caifeng
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Epidemiology and Endoscope, Shexian Cancer Institute, Shexian, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Epidemiology and Endoscope, Shexian Cancer Institute, Shexian, China.
authors.forename: Junli
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiaoduo
authors.initials: X
authors.lastname: Wen
authors.affiliation: Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Endoscope, Shexian Cancer Institute, Shexian, China.
authors.forename: Fuzhi
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Endoscope, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Shijie
authors.initials: S
authors.lastname: Wang
authors.affiliation: Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Baoen
authors.initials: B
authors.lastname: Shan
mesh_terms: D000367:Age Factors; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005544:Forecasting; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012737:Sex Factors; D013997:Time Factors
keywords: endoscopic surveillance; esophageal cancer; gastric cardia cancer; population-based screening; precursor progression; risk factors