title: Risk stratification for malignant progression in Barrett's esophagus: Gender, age, duration and year of surveillance.
abstract: OBJECTIVE
  To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.
  
  
  METHODS
  Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.
  
  
  RESULTS
  One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.
  
  
  CONCLUSIONS
  The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.
authors.affiliation: Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett's Oesophagus Registry, UCL, NW32QG London, United Kingdom.
authors.forename: Piers
authors.initials: P
authors.lastname: Gatenby
authors.affiliation: Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett's Oesophagus Registry, UCL, NW32QG London, United Kingdom.
authors.forename: Santanu
authors.initials: S
authors.lastname: Bhattacharjee
authors.affiliation: Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett's Oesophagus Registry, UCL, NW32QG London, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Wall
authors.affiliation: Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett's Oesophagus Registry, UCL, NW32QG London, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Caygill
authors.affiliation: Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett's Oesophagus Registry, UCL, NW32QG London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Watson
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D057832:Watchful Waiting / Q000706:statistics & numerical data*
keywords: Barrett’s esophagus; Dysplasia; Epidemiology; Esophageal neoplasms; Public health; Surveillance