Predictors for neoplastic progression in patients with Barrett's esophagus: A prospective cohort study

M. Sikkema, C. W N Looman, E. W. Steyerberg, M. Kerkhof, F. Kastelein, H. Van Dekken, A. J. Van Vuuren, W. A. Bode, H. Van Der Valk, R. J T Ouwendijk, R. Giard, W. Lesterhuis, R. Heinhuis, E. C. Klinkenberg, G. A. Meijer, F. Ter Borg, J. W. Arends, J. J. Kolkman, J. Van Baarlen, R. A. De VriesA. H. Mulder, A. J P Van Tilburg, G. J A Offerhaus, F. J W Ten Kate, J. G. Kusters, E. J. Kuipers, P. D. Siersema

Research output: Contribution to journalArticle

Abstract

Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. Methods: We included 713 patients with BE (2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. Results: After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). Conclusions: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of 10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.

Original languageEnglish (US)
Pages (from-to)1231-1238
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume106
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Barrett Esophagus
Cohort Studies
Prospective Studies
Adenocarcinoma
Odds Ratio
Confidence Intervals
Esophagitis
Gastrointestinal Endoscopy
Tobacco Use
Linear Models
Histology
Body Mass Index
Regression Analysis
Alcohols

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Sikkema, M., Looman, C. W. N., Steyerberg, E. W., Kerkhof, M., Kastelein, F., Van Dekken, H., ... Siersema, P. D. (2011). Predictors for neoplastic progression in patients with Barrett's esophagus: A prospective cohort study. American Journal of Gastroenterology, 106(7), 1231-1238. https://doi.org/10.1038/ajg.2011.153

Predictors for neoplastic progression in patients with Barrett's esophagus : A prospective cohort study. / Sikkema, M.; Looman, C. W N; Steyerberg, E. W.; Kerkhof, M.; Kastelein, F.; Van Dekken, H.; Van Vuuren, A. J.; Bode, W. A.; Van Der Valk, H.; Ouwendijk, R. J T; Giard, R.; Lesterhuis, W.; Heinhuis, R.; Klinkenberg, E. C.; Meijer, G. A.; Borg, F. Ter; Arends, J. W.; Kolkman, J. J.; Van Baarlen, J.; De Vries, R. A.; Mulder, A. H.; Van Tilburg, A. J P; Offerhaus, G. J A; Ten Kate, F. J W; Kusters, J. G.; Kuipers, E. J.; Siersema, P. D.

In: American Journal of Gastroenterology, Vol. 106, No. 7, 07.2011, p. 1231-1238.

Research output: Contribution to journalArticle

Sikkema, M, Looman, CWN, Steyerberg, EW, Kerkhof, M, Kastelein, F, Van Dekken, H, Van Vuuren, AJ, Bode, WA, Van Der Valk, H, Ouwendijk, RJT, Giard, R, Lesterhuis, W, Heinhuis, R, Klinkenberg, EC, Meijer, GA, Borg, FT, Arends, JW, Kolkman, JJ, Van Baarlen, J, De Vries, RA, Mulder, AH, Van Tilburg, AJP, Offerhaus, GJA, Ten Kate, FJW, Kusters, JG, Kuipers, EJ & Siersema, PD 2011, 'Predictors for neoplastic progression in patients with Barrett's esophagus: A prospective cohort study', American Journal of Gastroenterology, vol. 106, no. 7, pp. 1231-1238. https://doi.org/10.1038/ajg.2011.153
Sikkema, M. ; Looman, C. W N ; Steyerberg, E. W. ; Kerkhof, M. ; Kastelein, F. ; Van Dekken, H. ; Van Vuuren, A. J. ; Bode, W. A. ; Van Der Valk, H. ; Ouwendijk, R. J T ; Giard, R. ; Lesterhuis, W. ; Heinhuis, R. ; Klinkenberg, E. C. ; Meijer, G. A. ; Borg, F. Ter ; Arends, J. W. ; Kolkman, J. J. ; Van Baarlen, J. ; De Vries, R. A. ; Mulder, A. H. ; Van Tilburg, A. J P ; Offerhaus, G. J A ; Ten Kate, F. J W ; Kusters, J. G. ; Kuipers, E. J. ; Siersema, P. D. / Predictors for neoplastic progression in patients with Barrett's esophagus : A prospective cohort study. In: American Journal of Gastroenterology. 2011 ; Vol. 106, No. 7. pp. 1231-1238.
@article{6e979a2fc33d41d19486428795b42572,
title = "Predictors for neoplastic progression in patients with Barrett's esophagus: A prospective cohort study",
abstract = "Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. Methods: We included 713 patients with BE (2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. Results: After 4 years of follow-up, 26/713 (3.4{\%}) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of 10 years (risk ratio (RR) 3.2; 95{\%} confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95{\%} CI 1.01-1.2), esophagitis (RR 3.5; 95{\%} CI 1.3-9.5), and LGD (RR 9.7; 95{\%} CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3{\%} and up to 40{\%}. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (1{\%}), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40{\%}). Conclusions: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of 10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.",
author = "M. Sikkema and Looman, {C. W N} and Steyerberg, {E. W.} and M. Kerkhof and F. Kastelein and {Van Dekken}, H. and {Van Vuuren}, {A. J.} and Bode, {W. A.} and {Van Der Valk}, H. and Ouwendijk, {R. J T} and R. Giard and W. Lesterhuis and R. Heinhuis and Klinkenberg, {E. C.} and Meijer, {G. A.} and Borg, {F. Ter} and Arends, {J. W.} and Kolkman, {J. J.} and {Van Baarlen}, J. and {De Vries}, {R. A.} and Mulder, {A. H.} and {Van Tilburg}, {A. J P} and Offerhaus, {G. J A} and {Ten Kate}, {F. J W} and Kusters, {J. G.} and Kuipers, {E. J.} and Siersema, {P. D.}",
year = "2011",
month = "7",
doi = "10.1038/ajg.2011.153",
language = "English (US)",
volume = "106",
pages = "1231--1238",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - Predictors for neoplastic progression in patients with Barrett's esophagus

T2 - A prospective cohort study

AU - Sikkema, M.

AU - Looman, C. W N

AU - Steyerberg, E. W.

AU - Kerkhof, M.

AU - Kastelein, F.

AU - Van Dekken, H.

AU - Van Vuuren, A. J.

AU - Bode, W. A.

AU - Van Der Valk, H.

AU - Ouwendijk, R. J T

AU - Giard, R.

AU - Lesterhuis, W.

AU - Heinhuis, R.

AU - Klinkenberg, E. C.

AU - Meijer, G. A.

AU - Borg, F. Ter

AU - Arends, J. W.

AU - Kolkman, J. J.

AU - Van Baarlen, J.

AU - De Vries, R. A.

AU - Mulder, A. H.

AU - Van Tilburg, A. J P

AU - Offerhaus, G. J A

AU - Ten Kate, F. J W

AU - Kusters, J. G.

AU - Kuipers, E. J.

AU - Siersema, P. D.

PY - 2011/7

Y1 - 2011/7

N2 - Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. Methods: We included 713 patients with BE (2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. Results: After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). Conclusions: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of 10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.

AB - Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. Methods: We included 713 patients with BE (2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. Results: After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). Conclusions: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of 10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.

UR - http://www.scopus.com/inward/record.url?scp=79960069342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960069342&partnerID=8YFLogxK

U2 - 10.1038/ajg.2011.153

DO - 10.1038/ajg.2011.153

M3 - Article

C2 - 21577245

AN - SCOPUS:79960069342

VL - 106

SP - 1231

EP - 1238

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 7

ER -