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Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett's cohort.
Am J Gastroenterol. 2005 Apr; 100(4):775-83.AJ

Abstract

OBJECTIVES

No published data are available on the risk of further neoplastic progression in Barrett's patients stratified by baseline dysplasia status. Our aims were to estimate and compare the risk of progression to high-grade dysplasia or cancer in groups of Barrett's patients stratified by baseline dysplasia status.

METHODS

Consecutive Barrett's cases from 1988-2002 were identified via pathology databases in a regional VA health-care system and medical record data were abstracted. The risk of progression to high-grade dysplasia or cancer was measured and compared in cases with versus without low-grade dysplasia within 1 yr of index endoscopy using survival analysis.

RESULTS

A total of 575 Barrett's cases had 2,775 patient-years of follow-up. There were 13 incident cases of high-grade dysplasia and two of cancer. The crude rate of high-grade dysplasia or cancer was 1 of 78 patient-years for those with baseline dysplasia versus 1 of 278 patient-years for those without (p= 0.001). One case of high-grade dysplasia in each group underwent successful therapy. One incident cancer case underwent successful resection and the other was unresectable. Two cases with high-grade dysplasia later developed cancer, one died postoperatively, the other was unresectable. When these two cases were included (total of four cancers), the crude rate of cancer was 1 of 274 patient-years for those with baseline dysplasia versus 1 of 1,114 patient-years for those without.

CONCLUSIONS

In a large cohort study of Barrett's, incident malignancy was uncommon. The rate of progression to high-grade dysplasia or cancer was significantly higher in those with baseline low-grade dysplasia. These data may warrant reevaluation of current Barrett's surveillance strategies.

Authors+Show Affiliations

Greater Los Angeles Veterans Administration Healthcare System, Department of Medicine, Division of Gastroenterology, UCLA School of Medicine, Los Angeles, CA 90073, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15784018

Citation

Dulai, Gareth S., et al. "Dysplasia and Risk of Further Neoplastic Progression in a Regional Veterans Administration Barrett's Cohort." The American Journal of Gastroenterology, vol. 100, no. 4, 2005, pp. 775-83.
Dulai GS, Shekelle PG, Jensen DM, et al. Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett's cohort. Am J Gastroenterol. 2005;100(4):775-83.
Dulai, G. S., Shekelle, P. G., Jensen, D. M., Spiegel, B. M., Chen, J., Oh, D., & Kahn, K. L. (2005). Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett's cohort. The American Journal of Gastroenterology, 100(4), 775-83.
Dulai GS, et al. Dysplasia and Risk of Further Neoplastic Progression in a Regional Veterans Administration Barrett's Cohort. Am J Gastroenterol. 2005;100(4):775-83. PubMed PMID: 15784018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett's cohort. AU - Dulai,Gareth S, AU - Shekelle,Paul G, AU - Jensen,Dennis M, AU - Spiegel,Brennan M R, AU - Chen,Jaime, AU - Oh,David, AU - Kahn,Katherine L, PY - 2005/3/24/pubmed PY - 2005/4/30/medline PY - 2005/3/24/entrez SP - 775 EP - 83 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 100 IS - 4 N2 - OBJECTIVES: No published data are available on the risk of further neoplastic progression in Barrett's patients stratified by baseline dysplasia status. Our aims were to estimate and compare the risk of progression to high-grade dysplasia or cancer in groups of Barrett's patients stratified by baseline dysplasia status. METHODS: Consecutive Barrett's cases from 1988-2002 were identified via pathology databases in a regional VA health-care system and medical record data were abstracted. The risk of progression to high-grade dysplasia or cancer was measured and compared in cases with versus without low-grade dysplasia within 1 yr of index endoscopy using survival analysis. RESULTS: A total of 575 Barrett's cases had 2,775 patient-years of follow-up. There were 13 incident cases of high-grade dysplasia and two of cancer. The crude rate of high-grade dysplasia or cancer was 1 of 78 patient-years for those with baseline dysplasia versus 1 of 278 patient-years for those without (p= 0.001). One case of high-grade dysplasia in each group underwent successful therapy. One incident cancer case underwent successful resection and the other was unresectable. Two cases with high-grade dysplasia later developed cancer, one died postoperatively, the other was unresectable. When these two cases were included (total of four cancers), the crude rate of cancer was 1 of 274 patient-years for those with baseline dysplasia versus 1 of 1,114 patient-years for those without. CONCLUSIONS: In a large cohort study of Barrett's, incident malignancy was uncommon. The rate of progression to high-grade dysplasia or cancer was significantly higher in those with baseline low-grade dysplasia. These data may warrant reevaluation of current Barrett's surveillance strategies. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/15784018/Dysplasia_and_risk_of_further_neoplastic_progression_in_a_regional_Veterans_Administration_Barrett's_cohort_ L2 - http://Insights.ovid.com/pubmed?pmid=15784018 DB - PRIME DP - Unbound Medicine ER -