Data on cancer risk in patients with long-segment Barrett's esophagus (BE) from older studies are often difficult to interpret, since the definition of BE has evolved from an endoscopical to a histological diagnosis.
In this work, Dr Hage and colleagues from The Netherlands, the diagnoses in the Rotterdam BE cohort on current standards was redefined to obtain more accurate data on cancer risk in patients who had not undergone standard endoscopic surveillance.
In addition, the researcgers determined which patient factors present at index endoscopy were associated with neoplastic progression in BE.
The Rotterdam BE cohort analyzed by the research team, comprises all patients with ≥3 cm BE, diagnosed at endoscopy between 1973 and 1984.
The researchers only included patients with intestinal metaplasia in this study, totaling 105 participants.
The research team obtained follow-up data by questionnaires and/or interviews with patients or treating physicians. They then used a Kaplan-Meier analysis to estimate 20-year risks.
|1 cancer case per 221 patient-years and 1 case of high-grade dysplasia per 266 patient-years|
|Scandinavian Journal of Gastroenterology|
The researchers found that the mean length of the BE was 7.1 cm (range: 3-15 m).
In addition, the researchers noted that cancer in BE developed in 6% of patients, and high-grade dysplasia (HGD) in 5% during 1329 patient-years of follow-up.
This equates to 1 cancer case per 221 patient-years and 1 HGD case per 266 patient-years.
The research team recorded 72 deaths (69% of patients) after a mean follow-up of 12.7 years; only 4 of them died of esophageal cancer or its treatment.
The researchers found that a longer length of BE was associated with an increased risk of progression to HGD or cancer.
6 of 24 patients who never had low-grade dysplasia progressed to HGD or cancer 2-16 years after a diagnosis of BE.
Dr Hage concluded, "The annual risk of developing HGD or adenocarcinoma in patients with long-segment BE is 0.83%."
"Death due to adenocarcinoma is, however, uncommon, even in a cohort of patients with long-segment BE."