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Independent Blinded Validation of a Tissue Systems Pathology Test to Predict Progression in Patients With Barrett's Esophagus.

预测 Barrett 食管患者进展的组织系统病理学检测的独立盲法验证。

  • 影响因子:4.03
  • DOI:10.14309/ajg.0000000000000556
  • 作者列表:"Davison JM","Goldblum J","Grewal US","McGrath K","Fasanella K","Deitrick C","DeWard AD","Bossart EA","Hayward SL","Zhang Y","Critchley-Thorne RJ","Thota PN
  • 发表时间:2020-02-18
Abstract

INTRODUCTION:A risk prediction test was previously validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE). The aim of our study was to independently validate this test to predict the risk of progression to HGD/EAC in BE patients with nondysplastic (ND), indefinite for dysplasia and low-grade dysplasia (LGD). METHODS:A single-blinded, case-control study was conducted to stratify patients with BE as low, intermediate, or high risk for progression to HGD/EAC within 5 years using a previously described risk prediction test. Patients with BE who progressed to HGD/EAC after at least 1 year (n = 58) were matched to patients undergoing surveillance without progression (n = 210, median surveillance 7 years). Baseline biopsies with subspecialist diagnoses of ND, indefinite for dysplasia, or LGD were tested in a blinded manner, and the predictive performance of the test was assessed. RESULTS:This risk prediction test stratified patients with BE based on progression risk with the high-risk group at 4.7-fold increased risk for HGD/EAC compared with the low-risk group (95% confidence interval 2.5-8.8, P < 0.0001). Prevalence-adjusted positive predictive value at 5 years was 23%. The high-risk class and male sex provided predictive power that was independent of pathologic diagnosis, age, segment length, and hiatal hernia. Patients with ND BE who scored high risk progressed at a higher rate (26%) than patients with subspecialist-confirmed LGD (21.8%) at 5 years. DISCUSSION:A risk prediction test identifies patients with ND BE who are at high risk for progression to HGD/EAC and may benefit from early endoscopic therapy or increased surveillance.

摘要

简介: 先前验证了一项风险预测试验,以预测 Barrett 食管 (BE) 患者进展为高度异型增生 (HGD) 和食管腺癌 (EAC)。我们研究的目的是独立验证该试验以预测非发育不良 (ND) BE 患者进展为 HGD/EAC 的风险。对发育不良和低度发育不良 (LGD) 不确定。 方法: 采用单盲、病例对照研究,对 BE 为低、中、或使用先前描述的风险预测试验在 5 年内进展为 HGD/EAC 的高风险。至少 1 年后进展至 HGD/EAC 的 BE 患者 (n = 58) 与接受监测而无进展的患者 (n = 210,中位监测 7 年) 相匹配。以盲法检测亚专科诊断为 ND 、不明确为发育不良或 LGD 的基线活检,并评估检测的预测性能。 结果: 该风险预测试验基于进展风险将 BE 患者分层,高风险组与低风险组相比 HGD/EAC 风险增加 4.7 倍 (95% 置信区间 2.5 -8.8, P

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作者列表:["Shang L","Pei QS","Xu D","Liu JY","Liu J"]

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影响因子:2.64
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