External validation of a model determining risk of neoplastic progression of Barrett’s esophagus in a cohort of U.S. veterans

Wenker, Theresa Nguyen; Thrift, Aaron P.; Ketwaroo, Gyanprakash A.; Du, Xianglin L.; Novelo, Luis Leon; George, Rollin; Rosen, Daniel; El–Serag, Hashem B.

doi:10.1016/j.gie.2021.12.034

Cited by 3 publications

(5 citation statements)

References 30 publications

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“…In addition, this system has a three-risk group categorization, which can be difficult to interpret, specifically in intermediate scores. 9 Nevertheless, when validated in our cohort the PIB score accomplished an AUC of 0.75, which was comparable to the AUC of the currently developed model. Therefore, both our model and the PIB score are simple and concise scores for predicting histologic progression in patients with NDBE at baseline.…”

Section: Discussionsupporting

confidence: 76%

“…'s PIB score uses several parameters, including the presence of LGD, as predictors of progression to HGD/EAC, but this scoring system is not specifically directed to the NDBE population and was developed using a heterogenic group of BE patients with and without dysplasia at baseline. In addition, this system has a three‐risk group categorization, which can be difficult to interpret, specifically in intermediate scores 9 . Nevertheless, when validated in our cohort the PIB score accomplished an AUC of 0.75, which was comparable to the AUC of the currently developed model.…”

Section: Discussionsupporting

confidence: 59%

“…Only a few prediction models in patients with BE have been previously developed using clinical, endoscopic, genetic, and molecular parameters, and even less have been validated. 8,9,19,20 The previously validated Parasa et al's PIB score uses several parameters, including the presence of LGD, as predictors of progression to HGD/EAC, but this scoring system is not specifically directed to the NDBE population and was developed using a heterogenic group of BE patients with and without dysplasia at baseline. In addition, this system has a three-risk group categorization, which can be difficult to interpret, specifically in intermediate scores.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Previous attempts have been made to create and validate prognostic tools in the BE population, [8][9][10][11] but most studies incorporate the presence of dysplasia in their model and are not specific to the NDBE population. In addition, the primary end-point of previous models was a composite of HGD/EAC; however, in patients with NDBE the progression to even low-grade dysplasia (LGD) is important, as these patients should be treated according to international guidelines, 12 or followed up in a very strict fashion.…”

Section: Introductionmentioning

confidence: 99%

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Development and validation of a prediction model for histologic progression in patients with nondysplastic Barrett's esophagus

Peleg

Ringel

Shamah

et al. 2023

Digestive Endoscopy

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ObjectivesPatients with Barrett's esophagus (BE) are at risk of progression to esophageal adenocarcinoma (EAC). We developed a model to predict histologic progression in patients with nondysplastic BE (NDBE).MethodsA longitudinal study in three referral centers was performed between January 2010 and December 2019. As progression to low‐grade dysplasia (LGD) can be considered an indication for ablative therapy, the study end‐point was histopathologic progression to LGD, high‐grade dysplasia, or EAC at 3 years after diagnosis. We used logistic regression to create the model. Seventy percent of the cohort were used to stem the model and the remaining 30% for internal validation.ResultsA total of 542 patients were included, 69.4% of whom were male, mean age 62.2 years. Long‐segment BE at index endoscopy was diagnosed in 20.8% of the patients. After a mean follow‐up of 6.7 years, 133 patients (24.5%) had histologic progression. Our model identified a neutrophil‐to‐lymphocyte ratio (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.77–2.32, P < 0.001), BE length (OR 1.22, 95% CI 1.09–1.36, P < 0.001), age (OR 1.03, 95% CI 1.02–1.05, P = 0.02), smoking (OR 1.66, 95% CI 1.09–2.75, P = 0.04), and renal failure (OR 1.51, 95% CI 0.93–2.43, P = 0.07) as predictors of histologic progression at 3 years. The areas under the receiver operating characteristic curves of this model were 0.88 and 0.76 in the training and validation cohorts, respectively.ConclusionThis novel, internally validated model may predict histologic progression, even in patients with NDBE who generally have low rates of progression over time, and may contribute to enhanced patient selection for more intense surveillance programs.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Development and validation of a prediction model for histologic progression in patients with nondysplastic Barrett's esophagus

Peleg

Ringel

Shamah

et al. 2023

Digestive Endoscopy

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Risk-stratification models for Barrett’s esophagus: Will we get to the perfect classifier?

Chan

Pouw

2022

Gastrointestinal Endoscopy

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Categorizing Risks within Barrett's Esophagus To Guide Surveillance and Interception; Suggesting a New Framework

Honing

Fitzgerald

2023

Cancer Prevention Research

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Barrett's esophagus is a precancerous condition that can progress in a stepwise manner to dysplasia and eventually esophageal adenocarcinoma (EAC). Once diagnosed, patients with Barrett's esophagus are kept on surveillance to detect progression so that timely intervention can occur with endoscopic therapy. Several demographic and clinical risk factors are known to increase progression toward EAC, such as longer Barrett's segments, and these patients are kept on tighter surveillance. While p53 IHC has been advocated as an adjunct to histopathologic diagnosis, use of this biomarker is variable, and no other molecular factors are currently applied. Given the new evidence available, it is time to consider whether other risk factors or tools could be applied in clinical practice to decide on closer or attenuated surveillance. In this commentary, we summarize the most relevant risk factors for Barrett's esophagus progression, highlight the most promising novel risk stratification tools—including nonendoscopic triage and commercial biomarker panels, and propose a new framework suggesting how to incorporate risk stratification into clinical practice.

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External validation of a model determining risk of neoplastic progression of Barrett’s esophagus in a cohort of U.S. veterans

Cited by 3 publications

References 30 publications

Development and validation of a prediction model for histologic progression in patients with nondysplastic Barrett's esophagus

Development and validation of a prediction model for histologic progression in patients with nondysplastic Barrett's esophagus

Risk-stratification models for Barrett’s esophagus: Will we get to the perfect classifier?

Categorizing Risks within Barrett's Esophagus To Guide Surveillance and Interception; Suggesting a New Framework

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