External validation of a model determining risk of neoplastic progression of Barrett's esophagus in a cohort of US veterans

被引:0
|
作者
Nguyen, Theresa H. [1 ,6 ]
Thrift, Aaron P. [2 ,4 ]
Ketwaroo, Gyanprakash A. [1 ]
Du, Xianglin L. [8 ]
Novelo, Luis Leon [9 ]
George, Rollin [1 ]
Rosen, Daniel G. [3 ,5 ,7 ]
El-Serag, Hashem B. [1 ,6 ]
机构
[1] Baylor Coll Med, Dept Med, Sect Gastroenterol & Hepatol, Houston, TX 77030 USA
[2] Baylor Coll Med, Dept Med, Sect Epidemiol & Populat Sci, Houston, TX 77030 USA
[3] Dan L Duncan Comprehens Canc Ctr, Houston, TX USA
[4] Baylor Coll Med, Dept Pathol, Houston, TX 77030 USA
[5] Baylor Coll Med, Houston, TX 77030 USA
[6] Michael E DeBakey VA Med Ctr, Ctr Innovat Qual Effectiveness & Safety, Houston, TX USA
[7] Michael E DeBakey VA Med Ctr, Dept Pathol, Houston, TX USA
[8] Univ Texas Houston, Sch Publ Hlth, Dept Epidemiol, Houston, TX USA
[9] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Dept Biostat & Data Sci, Houston, TX 77030 USA
关键词
LOW-GRADE DYSPLASIA; PRAGUE C; ADENOCARCINOMA; DIAGNOSIS; MANAGEMENT; PREVALENCE; GUIDELINES; ENDOSCOPY;
D O I
暂无
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: Risk of esophageal adenocarcinoma (EAC) in those with Barrett's esophagus (BE) is 11-fold greater than the general population. It remains unclear which BE patients are at highest risk of progression to EAC. We aimed to validate a predictive model risk-stratifying BE patients. Methods: We conducted a retrospective cohort study at the Houston Veteran Affairs Medical Center of consecutive patients with a new diagnosis of BE from November 1990 to January 2019. Study follow-up was through February 2020. Patients were excluded if they had no follow-up EGD with esophageal biopsy sampling after the initial BE-diagnosing EGD or evidence of high-grade dysplasia (HGD) or EAC on initial EGD. We performed an external validation study of a risk model containing sex, smoking, BE length, and low-grade dysplasia (LGD) status and assessed discriminatory ability using the area under the receiver operating characteristic curve (AUROC). Results: Among 608 BE patients, 24 progressed to HGD/EAC. The points-based model discriminated well with an AUROC of .72 (95% confidence interval [CI], .63-.82). When categorized into low-, intermediate-, and high-risk groups according to published cutoffs, the AUROC was poor at .57. Restructured into low-risk versus high-risk groups, the AUROC was .72 (95% CI, .64-.80). Excluding baseline LGD did not reduce discriminatory ability (AUROC, .73; 95% CI, .64-.82). Conclusions: This external validation provides further evidence that the model including sex, LGD status, smoking status, and BE length may help to risk stratify BE patients. A simplified version excluding LGD status and/or reducing the number of risk groups has increased utility in clinical practice without loss of discriminatory ability.
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页码:1113 / 1122
页数:10
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