ABSTRACT
BACKGROUND AND AIM: This study aimed to estimate the time to precursor progression and to identify significant predicators. METHODS: One hundred thirty-three precursor and 311 normal cases detected in a population-based screening were surveyed for 5.5 years. Precursor progression was defined as worsening of dysplasia or development of a new precursor. Time to precursor progression was estimated by the Kaplan-Meier method. Significant predicators were estimated by Cox proportional regression. RESULTS: Of the 133 precursor cases, 33.08% (44/133) progressed or recurred, 30.08% (40/133) persisted, and 36.84% (49/133) regressed; of the 311 normal subjects, 13.50% (42/311) developed a precursor. Progression occurred significantly earlier and more frequently with ncreasing histology: with mind dysplasia (mD), 7.8% progressed by 1 year and 23.3% progressed by 5 year; with moderate dysplasia (MD), 18% progressed by 1 year and 70% progressed by 5 years; and with severe dysplasia, 50% progressed by 1 year and 100% progressed by 5 years. The difference between any two groups was significant. In addition, the marginal Lugol-stained mucosa at endoscopic mucosal resection had a progressing risk similar to that of MD, and basal cell hyperplasia was similar to that of mD. Significant predicators for precursor progression included male sex (hazard ratio and 95% CI: 2.74 (1.63-4.60)), age over 50 years (2.31 (1.33-4.02)), family history of upper gastrointestinal cancer (UGIC) (1.56 (1.00-2.45)), multifocal dysplasia (5.11 (3.01-8.68)), and baseline histology. CONCLUSIONS: Sex, age, family history of UGIC, multifocal dysplasia, and baseline histology are significant independent predicators for precursor progression. Patients after endoscopic mucosal resection should be continuously surveyed.
Subject(s)
Esophageal Neoplasms/epidemiology , Esophageal Neoplasms/surgery , Age Factors , China/epidemiology , Disease Progression , Endoscopy, Gastrointestinal , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/prevention & control , Esophagus/surgery , Female , Forecasting , Humans , Kaplan-Meier Estimate , Male , Mass Screening , Middle Aged , Mucous Membrane/surgery , Neoplasm Recurrence, Local , Proportional Hazards Models , Sex Factors , Time FactorsABSTRACT
BACKGROUND: The study was conducted to examine esophageal and gastric cardia precursor progression. METHODS: After population-based baseline screening, 145 precursor and 335 chronic inflammation cases were endoscopically surveyed for six years. RESULTS: Surveillance of interval and baseline diagnoses for 18 severe dysplasia (SD) cases later detected were: 13, 23, 39, and 44 months since a diagnosis of chronic inflammation in four cases; 6, 6, 6, 11, 13, 16, 16, and 23 months since mild dysplasia (mD) diagnoses in eight; and 6, 9, 10, 13, 18, and 48 months since moderate dysplasia (MD) diagnoses in six. Rates for 11 carcinoma in situ (Cis) cases later detected were: 7 and 18 months since basal cell hyperplasia (Bch) diagnoses in two; and 6, 6, 9, 13, 13, 18, 35, 44, and 50 months since MD diagnoses in nine. In 10 cancer cases later detected, rates were: 6, 6, 7, 18, 19, 34, 36, and 48 months since SD diagnoses in eight cases with submucosal carcinoma; 46 months since MD diagnosis in a T 2 N 0 M 0 carcinoma case; and 52 months since Bch diagnosis in another T 2 N 0 M 0 case. CONCLUSION: Esophageal and gastric cardia precursors are heterogeneous. Male gender, advanced age, family history of upper gastrointestinal cancer, and multifocal dysplasia are significant independent predictors for progression, and Bch/mD, MD, and SD constitute three distinctive entities regarding the risk of cancer.