Abstract：
Esophageal adenocarcinoma (EAC) develops in a step-wise manner, from low-grade dysplasia (LGD) to high-grade dysplasia (HGD), and ultimately to invasive EAC. However, there remains diagnostic uncertainty about LGD and its risk of progression to HGD/EAC. The aim is to investigate the role of Ki-67, immune-histochemical marker of proliferation, surface expression in patients with confirmed LGD, and risk stratify progression to HGD/EAC. A retrospective cohort study was conducted. Patients with confirmed LGD and indefinite for dysplasia (IND), with a mean follow-up of ≥1 year, were included. Pathology specimens were stained for Ki-67 and analyzed for evidence of surface expression. Our results reveal that 29% of patients with confirmed LGD who stained positive with Ki-67 progressed to HGD/EAC as opposed to none (0%) of the patients who stained negative, a statistically significant result (P = 0.003). Similarly, specimens from patients with IND were stained and analyzed revealing a nonsignificant trend toward a higher rate of progression for Ki-67 positive cases versus Ki-67 negative, 30% versus 21%, respectively. Ki-67 expression by itself can identify patients with LGD at a high risk of progression.
摘要：
食管腺癌（EAC）以逐步的方式发展，从低度发育不良（LGD）到高度发育不良（HGD），最终是侵入性EAC。然而,关于LGD及其进展为HGD/EAC的风险仍存在诊断不确定性。目的是探讨增殖的免疫组织化学标记Ki-67的作用,已确诊的LGD患者的表面表达，和危险分层进展到HGD/EAC。进行了一项回顾性队列研究。确诊为LGD且不确定为发育不良（IND）的患者，平均随访时间≥1年，包括在内。对病理学标本进行Ki-67染色并分析表面表达的证据。我们的结果显示，29%的Ki-67染色阳性的确诊LGD患者进展为HGD/EAC，而没有染色阴性的患者(0%)，结果具有统计学意义(P=0.003)。同样，对IND患者的标本进行染色和分析，发现Ki-67阳性病例与Ki-67阴性病例相比，进展速率较高的趋势不显著，30%对21%，分别。Ki-67表达本身可以识别患有处于高进展风险的LGD的患者。
