This was a retrospective cohort study of BE patients seen in Cleveland Clinic and affiliated hospitals between January 2000 and August 2022. Demographics, endoscopic and histological findings, history of SOT and fundoplication, immunosuppressant use, and follow-up were abstracted.
The study population consisted of 3466 patients with BE, of which 115 had SOT (lung 35, liver 34, kidney 32, heart 14, and pancreas 2) and 704 patients on chronic immunosuppressants but no history of SOT. During a median follow-up of 5.1 years, there was no difference in the annual risk of progression between the three groups (SOT=0.61%, no SOT but on immunosuppressants= 0.82%, and no SOT/no immunosuppressants= 0.94%, p=0.72). On multivariate analysis, immunosuppressant use (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.04-1.82, p=0.025) but not SOT (OR 0.39, 95%CI 0.15-1.01, p=0.053) was associated with neoplastic progression in BE patients.
Immunosuppression is a risk factor for progression of BE to HGD/EAC. Therefore, close surveillance of BE patients on chronic immunosuppressants needs to be considered.
方法:这是2000年1月至2022年8月在克利夫兰诊所和附属医院就诊的BE患者的回顾性队列研究。人口统计,内窥镜和组织学发现,SOT和胃底折叠术的历史,使用免疫抑制剂,后续行动被抽象出来。
结果:研究人群包括3466例BE患者,其中115例患有SOT(肺35,肝34,肾32,心脏14和胰腺2),704例接受慢性免疫抑制剂但无SOT病史。在5.1年的中位随访期间,三组之间的年度进展风险没有差异(SOT=0.61%,没有SOT,但在免疫抑制剂=0.82%,无SOT/无免疫抑制剂=0.94%,p=0.72)。在多变量分析中,免疫抑制剂的使用(比值比(OR)1.38,95%置信区间(CI)1.04~1.82,p=0.025),而SOT(OR0.39,95CI0.15~1.01,p=0.053)与BE患者肿瘤进展无关.
结论:免疫抑制是BE进展为HGD/EAC的危险因素。因此,需要考虑密切监测慢性免疫抑制剂的BE患者.