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The risk of progression of Barrett's esophagus to esophageal adenocarcinoma is low and difficult to calculate. Accurate tools to determine risk are needed to optimize surveillance and intervention. Dr Rebecca Fitzgerald and colleagues from the United Kingdom assessed the ability of candidate biomarkers to predict which cases of Barrett's esophagus will progress to esophageal adenocarcinoma or high-grade dysplasia, and identified those that can be measured in formalin-fixed tissues. The researchers analyzed data from a nested case-control study performed using the population-based Northern Ireland Barrett's esophagus Register.  | | The risk increased by 2.99 for each additional factor in patients without dysplasia | | Gastroenterology |
Cases who progressed to esophageal adenocarcinoma or high-grade dysplasia 6 months or more after diagnosis with Barrett's esophagus were matched to controls, for age, sex, and year of Barrett's esophagus diagnosis. Established biomarkers and new biomarkers and binding of wheat germ agglutinin were assessed in paraffin-embedded tissue samples from patients with a first diagnosis of Barrett's esophagus. Conditional logistic regression analysis was applied to assess odds of progression for patients with dysplastic and nondysplastic Barrett's esophagus, based on biomarker status. The team tested low-grade dysplasia and all biomarkers tested, other than Lewisx, were associated with risk of esophageal adenocarcinoma or high-grade dysplasia. In backward selection, a panel comprising low-grade dysplasia, abnormal DNA ploidy, and AOL most accurately identified progressors and nonprogressors. The team found that the adjusted odds ratio for progression of patients with Barrett's esophagus with low-grade dysplasia was 3.7 for each additional biomarker. The team noted that the risk increased by 2.99 for each additional factor in patients without dysplasia. Dr Fitzgerald's team commented, "Low-grade dysplasia, abnormal DNA ploidy, and AOL can be used to identify patients with Barrett's esophagus most likely to develop esophageal adenocarcinoma or high-grade dysplasia."
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