Clinical prediction model for tumor progression in Barrett’s esophagus

Abstract

Background Individuals with Barrett’s esophagus (BE) are at increased risk of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC), but the cost-effectiveness of general surveillance of BE is low. This study aimed to identify a risk prediction model for tumor progression in individuals with BE based on age, sex, and risk factors found at upper endoscopy, enabling tailored surveillance. Methods This nested case–control study originated from a cohort of 8171 adults diagnosed with BE in 2006–2013 in the Swedish Patient Registry. Cases had EAC/HGD ( n = 279) as identified from the Swedish Cancer Registry, whereas controls had no EAC/HGD ( n = 1089). Findings from endoscopy and histopathology reports were extracted from medical records at 71 Swedish hospitals and from the Swedish Patient Registry. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CIs). Results Older age (OR 1.02 [95% CI 1.01–1.03] per year), male sex (OR 2.8 [95% CI 1.9–4.1]), and increasing maximum BE length (OR 2.3 [95% CI 1.4–3.9] for segments 3–8 cm and OR 4.3 [95% CI 2.5–7.2] for segments ≥ 8 cm) increased the risk of EAC/HGD, while the circumferential extent of the BE, hiatal hernia or reflux esophagitis did not. A model based on age, sex, and maximum BE length predicted 71% of all EAC/HGD cases. Conclusions A simple combination of the variables age, sex and maximum BE length showed fairly good accuracy for predicting tumor progression in BE. This clinical risk prediction model may help to tailor future surveillance programs. Electronic supplementary material The online version of this article (10.1007/s00464-018-6590-5) contains supplementary material, which is available to authorized users.

AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert Review

“…41 Other nonvalidated models using clinical variables have included the presence of esophagitis, lack of PPI use, being overweight, increasing age, and a known duration of BE of 10 years. [42][43][44][45][46] The panelists noted that several additional models were currently in development and noted that models incorporating both clinical and biomarker parameters would likely ultimately be needed to optimize predictive accuracy.…”

Barrett’s Metaplasia Progression towards Esophageal Adenocarcinoma: An Attempt to Select a Panel of Molecular Sensors and to Reflect Clinical Alterations by Experimental Models

“…There are several completed clinical trials focused on the effectiveness of well-known drugs used in the chemoprevention of BE and EAC [ 28 , 29 ]. However, taking into account that BE and EAC development is based on long-term and chronic exposure to GERD, these basic and clinical research areas are difficult to handle under experimental conditions [ 30 ]. Nevertheless, several in vitro and in vivo animal models of GERD leading to BE were developed [ 31 , 32 , 33 ].…”

Adherence to clinical guidelines for Barrett’s esophagus

“…The source cohort included all 8185 patients aged >18 years with Barrett's esophagus identified in the Swedish Patient Register (by the International Classification of Diseases [ICD] code K227) during the study period. As part of a case-control study nested within the source cohort, endoscopy and histopathology reports from 1368 patients with Barrett's esophagus at 83 endoscopy centers were retrieved and reviewed [8]. Based on this review, 299 patients with dysplastic Barrett's esophagus, according to the histopathology reports, were considered for this study, identified from 50 centers.…”