Barrett's recurrence more frequent in older, nonwhite patients
北卡罗来纳大学教堂山分校的William J. Bulsiewicz博士报告称，对美国148家医疗中心患者登记资料的回顾分析显示，与RFA治疗后BE未复发患者相比，复发者多为老年、非白人以及受累面积较大和治疗次数较少的患者。“上述风险危素提示BE患者之间存在生物学差异，这有助于我们更好地了解鳞状上皮细胞再生过程。”
双变量分析显示，与未复发者相比，复发患者平均年龄较高(63 vs. 61岁， P<0.01)，多为男性(77% vs. 71%，P=0.03)、受累食管较长(平均4.3 vs. 3.7 cm，P＜0.01)以及低分化不良或治疗前恶化者(54% vs. 45%，P＜0.01)。
研究者利用上述及其他患者资料和治疗特征进行逻辑回归模型分析，以考察是否存在可预测疾病复发的独立因素。结果显示，重要的复发独立预测因素包括非白人[比值比(OR)，2.47]、BE受累长度(OR，1.09/延长1 cm)、年龄(OR，1.02/增加1岁)以及初始疾病所需RFA治疗次数(OR，0.90 /治疗1次)，而复发风险与性别、治疗前发育不良、既往内镜黏膜切除或医院级别无关。
By: NEIL OSTERWEIL, Internal Medicine News Digital Network
ORLANDO – Age, race, and extent of disease treated appear to predict which patients will have a recurrence of Barrett’s esophagus after apparently successful radiofrequency ablation, investigators reported at the annual Digestive Disease Week.
A review of registry data from 148 centers in the United States shows that patients who experience a recurrence of Barrett’s after radiofrequency ablation (RFA) are more likely to be older, to be nonwhite, and to have had larger areas of involvement treated and fewer treatment sessions than patients with no recurrence, said Dr. William J. Bulsiewicz, of the University of North Carolina in Chapel Hill.
"These risk factors may point out biological differences between the populations [with Barrett’s] and help us to better understand the process of regeneration of squamous epithelium," he said.
There were recurrences in 28% of 1,602 patients who had complete eradication of intestinal metaplasia with RFA for Barrett’s and had at least 2 years of follow-up during which at least two biopsies were performed. The median time to recurrence was 1.4 years. Additionally, 33 patients were retreated for a suspected recurrence despite a lack of histological confirmation.
Based on a bivariate analysis of characteristics, patients with recurrent disease were more likely to have a higher mean age (63 vs. 61 years, P less than .01), to be male (77% vs. 71%, P = .03), to have longer esophageal segments with disease involvement (mean 4.3 vs. 3.7 cm, P less than .01), and to have low-grade dysplasia or worse prior to treatment (54% vs. 45%, P less than. 01).
The researchers used these and other patient and treatment characteristics in a logistic regression model to see which factors, if any, could independently predict recurrence.
Significant independent predictors of recurrence included nonwhite race (odds ratio, 2.47), length of the tubular esophagus with Barrett’s esophagus (OR, 1.09 per centimeter), age (OR, 1.02 per year), and number of RFA sessions required to treat initial disease (OR, 0.90 per treatment session).
Risk of recurrence was not associated with sex, pretreatment dysplasias, previous endoscopic mucosal resection, or treatment setting (academic medical center vs. community setting), Dr. Bulsiewicz said.
The investigators suggested that future surveillance protocols include age, race, esophageal length of Barrett’s involvement, and number of treatment sessions.
The study was funded by Covidien, GI Solutions, and the National Institutes of Health. Dr. Bulsiewicz reported having no financial disclosures.