Original ResearchClinical—Alimentary TractPopulation-Based Study Reveals New Risk-Stratification Biomarker Panel for Barrett's Esophagus
Section snippets
Study Design
A nested case-control study was conducted within the NIBR.5, 19, 20 The NIBR is a population-based register of all 9329 adults diagnosed with columnar-lined esophagus between 1993 and 2005 throughout Northern Ireland. Within the NIBR, 4306 patients with a visible columnar-lined segment displayed specialized intestinal metaplasia on biopsy and, for the purposes of this study, this definition was used for diagnosis of BE. Cases were BE patients from the NIBR who developed EAC, gastric cardia
Patient Demographics
After a mean (±standard deviation) follow-up period of 6.7 years (±3.3 y), 56 EAC, 13 gastric cardia cancers, and 25 HGD cases were diagnosed within the cohort. After review by 2 expert pathologists, 5 cases (2 EAC, 1 gastric cardia cancer, and 2 HGD cases) were found to have evidence of HGD or EAC at their initial BE diagnosis and therefore were excluded from analysis, leaving 89 cases. Table 1 shows the characteristics of these 89 cases and their 291 matched controls. Cases and controls did
Discussion
This population-based, phase 3, biomarker study has revealed a new combination panel for assessment of risk to progression from BE (±LGD) to EAC. The combination panel of 7 biomarkers represents a significant step to individualize patient risk and is advantageous owing to the use of relatively simple techniques that can be applied to formalin-fixed tissue. Furthermore, analysis of a simplified 3-biomarker panel model showed a significant stepwise increase risk of progression for AOL, DNA
Acknowledgments
The authors would like to extend their thanks for the input of all staff in the Centre for Public Health at Queen's University Belfast, past and present, who have contributed to the development of the Northern Ireland Barrett's esophagus register.
Elizabeth Bird–Lieberman, Jason Dunn, and Helen Coleman contributed equally to this work.
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Conflicts of interest The authors disclose no conflicts.
Funding This work was funded by a grant from the Medical Research Council and was supported by the University College London Experimental Cancer Medicine Centre, the Cambridge Experimental Cancer Medicine Centre (Cambridge and University College London), and the National Institute for Health Research Cambridge Biomedical Research Centre. Work undertaken at University College London Hospital/ University College London received a portion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health. The work also was supported by funding from a research fellowship from GlaxoSmithKline (E.B.-L.). The Northern Ireland Barrett's esophagus register has received financial support from the Ulster Cancer Foundation and the Health and Social Care Research and Development Office, Northern Ireland.