NEW YORK (Reuters Health) – A newly developed scoring system may be able to identify patients with Barrett’s esophagus (BE) at low, intermediate, and high risk for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC), researchers say.
Dr. Prateek Sharma of the Department of Veterans Affairs Medical Center in Kansas City, Missouri, told Reuters Health, “Since the vast majority of BE patients will never develop cancer or HGD, our current practice is to perform surveillance for all these patients.”
“On the other hand,” he said by email, “the minority of those who are at high risk for progression cannot be identified.”
“So, finally, after years at searching for biomarkers, risk factors, etc., this multicenter consortium has (found) easily identifiable factors – male gender, smoking, BE length, and low-grade dysplasia.”
“Each of these risk factors has been assigned points and weight (to produce the) progression of Barrett’s esophagus (PIB) score,” he explained. “This is very similar to the MELD scoring system for liver disease, for example.”
Dr. Sharma and colleagues analyzed data, from patients with BE at five centers in the U.S. and one in the Netherlands, gathered from 1985 through 2014.
As reported online December 19 in Gastroenterology, the analysis included 2,697 patients: mean age, 55; 84% male; 88% white; mean length of BE, 3.7 cm. Seventy percent of patients were used to derive the PIB risk-score model; 30% were used for the validation study. Median follow-up was 5.9 years.
During follow-up, 5.7% of patients developed either HGD or EAC. Male sex, smoking, length of BE, and baseline-confirmed low-grade dysplasia were significantly associated with progression, according to the authors.
The assigned scores identified patients who progressed. The report includes two examples:
1. 65-year-old man with a history of smoking, BE length of 5 cm, and non-dysplastic BE histology on index endoscopy.
Total score = 9 (male) + 5 (history of smoking) + 5 (BE length 5 cm) + 0 (non-dysplastic BE) = 19. This patient is at intermediate risk, with a 0.73% per year risk of progression to HGD/EAC.
2. 55-year-old woman with no history of smoking, BE length of 2 cm, and non-dysplastic BE on histology on index endoscopy.
Total score = 0 (female) + 0 (no history of smoking) + 2 (BE length 2 cm) + 0 (non-dysplastic BE) = 2. This patient is at low risk, with a 0.13% per year risk of progression to HGD/EAC.
At seven years, the hazard ratios for progression to HGD/EAC by risk category were 18.4 for the high-risk group (score: 21+ points) and 5.6 for the intermediate-risk group (11-20 points), compared to the low-risk group (0-10 points).
From a clinical standpoint, Dr. Sharma said, “Patients with a low score probably need reassurance; for high-risk patients, consider ablation or very close follow-up.” Those at intermediate risk should be monitored for three to five years.
Dr. Yujin Hoshida of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City commented, “The risk score was developed and validated in a large collection of multicenter patient cohorts with long-term follow-up using clinically readily available variables.”
“Therefore,” he told Reuters Health by email, “it is expected that the robustness and clinical applicability of the score is high, and such a score will make monitoring of patients at risk of developing esophageal cancer more efficient and cost-effective.”
“External validation and head-to-head comparison with previously reported scores will further elucidate the clinical utility of the score,” Dr. Hoshida concluded.
SOURCE: http://bit.ly/2pHp1Gd
Gastroenterology 2017.
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