Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression

Kastelein, Florine; Olphen, Sophie H. van; Steyerberg, Ewout W.; Spaander, Manon C.W.; Bruno, Marco J.

doi:10.1136/gutjnl-2014-308802

Cited by 62 publications

(57 citation statements)

References 40 publications

(39 reference statements)

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“…We also assume that being in an endoscopic surveillance program results in cancer detected at an early stage that will result in the likelihood of curative intervention with surgery. This has been the basis for all the international guidance on BE surveillance but recent data show that actually even though cancer may be detected early there may not actually be a difference in survival in these patients [7]. However, the model aims to capture mean inputs for the average patient and find a balance between a model structure that is too complex or simple dependent, in part, on the data available with which to populate the model.…”

Section: Discussionmentioning

confidence: 99%

“…They found that OAC was diagnosed at an earlier stage during BE surveillance than in the general population. However, the survival of patients with BE with neoplastic progression was not significantly worse than those of patients without neoplastic progression, and was similar to survival of patients with stage 0 or stage 1 OAC in the general population [7]. In patients with OAC, the prognosis is poor with just over 15% patients being alive at 5 years [8].…”

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confidence: 99%

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Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

et al. 2017

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Aim:The aim was to evaluate the cost-effectiveness of endoscopic eradication therapy (EET) with combined endoscopic mucosal resection and radiofrequency ablation for the treatment of high-grade dysplasia (HGD) arising in patients with Barrett's esophagus compared with endoscopic surveillance alone in the UK. Materials & methods:The cost-effectiveness model consisted of a decision tree and modified Markov model. A lifetime time horizon was adopted with the perspective of the UK healthcare system. Results: The base case analysis estimates that EET for the treatment of HGD is cost-effective at a GB£20,000 cost-effectiveness threshold compared with providing surveillance alone for HGD patients (incremental cost-effectiveness ratio: GB£1272). Conclusion: EET is likely to be a cost-effective treatment strategy compared with surveillance alone in patients with HGD arising in Barrett's esophagus in the UK. Barrett's esophagus (BE) is a precancerous state that can develop into esophageal adenocarcinoma (OAC). BE exists in most patients in a metaplastic state and carries a very low risk of progression to invasive neoplasia and OAC in the region of 0.12-0.5% per year [1,2]. The 2013 British Society of Gastroenterology (BSG) guidelines advise that, in those patients with BE in whom there is no neoplasia, surveillance is recommended for those fit for endoscopy [3]. This is based on existing evidence from published studies which show that surveillance correlates with early-stage cancer diagnosis and likely improved survival from other cancers [4][5][6]. Recent work from the ProBar study group examined data from the Dutch cancer registry. They compared survival of patients with BE with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population. They found that OAC was diagnosed at an earlier stage during BE surveillance than in the general population. However, the survival of patients with BE with neoplastic progression was not significantly worse than those of patients without neoplastic progression, and was similar to survival of patients with stage 0 or stage 1 OAC in the general population [7]. In patients with OAC, the prognosis is poor with just over 15% patients being alive at 5 years [8].Current UK surveillance guidelines [3] recommend that patients with BE undergo endoscopy every 2-5 years. In some patients, no surveillance is recommended due to the negligible risk for cancer progression. The intervals are dependent on the length of BE and presence of intestinal metaplasia at the index endoscopy. However, in a minority of patients with BE there is a molecular and pathological transformation through various dysplastic stages to mucosal dysplasia and cancer and then finally invasive disease where it Cost-effectiveness analysis of endoscopic eradication therapy for treatment of highgrade dysplasia in Barrett's esophagus

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

et al. 2017

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“…Two recent studies show that participation in an adequately performed surveillance program reduces mortality from EAC 29 and that EAC is detected at an earlier stage during BE surveillance. 30 In our cohort, most of the patients who progressed were diagnosed with HGD or superficial EAC. A recent meta-analysis shows that PPI therapy is associated with a significantly decreased risk of progression to EAC or HGD.…”

Section: Discussionmentioning

confidence: 99%

Low risk of adenocarcinoma and high-grade dysplasia in patients with non-dysplastic Barrett’s esophagus: Results from a cohort from a country with low esophageal adenocarcinoma incidence

Pereira

Chaves

2015

United European Gastroenterology Journal

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Background: The risk of esophageal adenocarcinoma (EAC) in non-dysplastic Barrett's esophagus (NDBE) is considered to be approximately 0.3% per year or even lower, according to population-based studies. Data from countries with low EAC incidence are scarce. Our principal aim was to determine the incidence of high-grade dysplasia (HGD) and EAC in NDBE. Our secondary aims were to identify the predictors of progression and to calculate the incidence of HGD/EAC, by using the calculation method for surveillance time in population-based studies. Materials and methods: A cohort of NDBE patients was prospectively followed up. Cases of HGD and EAC (study end points) diagnosed during the first year of follow-up were considered as prevalent. Only cases with an endoscopic surveillance time > 1 year were included in our analysis. Results: We enrolled 331 patients (251 men) in the surveillance program. Their median age was 59 years (interquartile range (IQR): 47-67 years). Their median NDBE length was 3 cm (IQR: 2-4 cm). Of these patients, 80 died during the follow-up (one from EAC) and two were lost to follow-up. After 2284 patient-years of endoscopic follow-up (median surveillance time, 5 years (IQR: 2-10 years)), we found that five cases of HGD and two cases of EAC were diagnosed. The incidence of HGD/EAC was 3.1 cases per 1000 patient-years (95% CI: 1.3-6.0) and that of EAC was 0.9 (95% CI: 0.2-2.9). The incidence of HGD/EAC in short segments ( 3 cm) was 0.7 cases per 1000 patient-years (95% CI: 0.3-3.4). The sole variable that we found associated with progression was NDBE length. If the total surveillance time was considered (3537 patient-years), the incidence of HGD and EAC was only slight lower. Conclusions: The incidence of HGD and EAC was very low in NDBE. Therefore, current surveillance guidelines must be reassessed, at least for short-segment BE.

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“…BM is considered to be a premalignant condition, predisposing patients to an increased risk of oesophageal adenocarcinoma (EAC). Studies have shown that EACs detected in patients with BM undergoing surveillance tend to be of lower stage and to have a better outcome than EACs detected in patients not enrolled in surveillance programmes …”

Section: Introductionmentioning

confidence: 99%

p53 protein accumulation predicts malignant progression in Barrett's metaplasia: a prospective study of 275 patients

et al. 2017

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Aims The purpose of this study was to determine prospectively whether p53 protein accumulation in biopsies of Barrett’s metaplasia (BM) is a predictor of malignant progression, without relying on dysplasia grading. Methods and results Sections of formalin fixed paraffin embedded tissue from the initial biopsies of 275 patients with BM, who had no high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC), were stained for p53 by immunohistochemistry. Mean follow up was 41 months. p53-positive biopsies were divided into 4 groups: scattered positive cells, multifocal scattered positive cells, aggregates of positive cells, and multifocal aggregates of positive cells. Kaplan-Meier analysis with the log-rank test was used to determine the rate of progression to high grade dysplasia (HGD)/esophageal adenocarcinoma (EAC). Of the 275 patients, 227 had initial biopsies completely negative for p53 and of these one (0.4%) progressed to HGD/EAC; none of 24 (0%) patients with scattered positive cells and none of 4 (0%) of patients with multifocal scattered positive cells progressed. By contrast, 5 of 16 (31.25%) patients with aggregates of positive cells and 3 of 4 (75%) of those with multifocal aggregates of positive cells progressed to HGD/EAC. Kaplan-Meier analysis with log rank statistics showed the difference in progression rate between the five groups to be highly significant (p<0.0001). Conclusions We conclude that p53 protein accumulation, detected by IHC in aggregates of cells, is a significant predictor of malignant progression in patients with BM.

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Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression

Abstract: OAC is detected at an earlier stage during BO surveillance than in the general population with good survival rates.

Cited by 62 publications

References 40 publications

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

Low risk of adenocarcinoma and high-grade dysplasia in patients with non-dysplastic Barrett’s esophagus: Results from a cohort from a country with low esophageal adenocarcinoma incidence

p53 protein accumulation predicts malignant progression in Barrett's metaplasia: a prospective study of 275 patients

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