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Odze R, Frei N, Khoshiwal AM, Duits LC, Bergman J, Stachler MD. Degree of crypt atypia correlates with progression to high-grade dysplasia/adenocarcinoma in non-dysplastic Barrett's oesophagus. Histopathology 2023; 83:406-413. [PMID: 37199687 PMCID: PMC10562012 DOI: 10.1111/his.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
AIMS Patients with non-dysplastic Barrett's oesophagus (BE) often show a wide range of 'atypical' histological features in the bases of the crypts. However, the significance of crypt atypia has never been evaluated, despite prior studies showing the presence of DNA content and other molecular abnormalities in this epithelium. The aim of this study was to evaluate whether the degree of crypt atypia in BE patients without dysplasia correlates with progression to high-grade dysplasia/adenocarcinoma (HGD/EAC). METHODS AND RESULTS Baseline biopsies from 114 BE patients without dysplasia, 57 who progressed to HGD/EAC (progressors) and 57 who did not progress (non-progressors), were included in the study. Biopsies were evaluated for the degree of basal crypt atypia on a three-point scale according to discrete histological criteria. In non-progressors, 64.9, 31.6 and 3.5% of biopsies had a crypt atypia score of 1, 2 and 3, respectively, with a mean score of 1.39 ± 0.56. The percentage of biopsies with an atypia score of 2 or 3 increased in progressors [42.1, 42.1 and 15.8% of biopsies scored 1, 2 or 3, respectively, with a mean score of 1.74 ± 0.72 (P = 0.004)]. The odds ratio of grade 3 crypt atypia for progression to HGD/EAC was 5.2 (95% confidence interval = 1.1-25.0, P = 0.04) and the findings did not change significantly when the data were analysed according to progression to either HGD or EAC. CONCLUSIONS This study shows that non-dysplastic crypts in BE are biologically abnormal, suggesting that neoplastic progression begins prior to the onset of dysplasia. The degree of crypt atypia in BE patients without dysplasia correlates with progression.
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Affiliation(s)
- Robert Odze
- Tufts university school of medicine Boston, MA, United States
| | - Nicola Frei
- Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
| | - Amir M Khoshiwal
- Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
| | - Lucas C Duits
- Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
| | - Jacques Bergman
- Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands
| | - Matthew D Stachler
- Dept of Pathology, University of California San Francisco, San Francisco, CA, United States
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Redston M, Noffsinger A, Kim A, Akarca FG, Rara M, Stapleton D, Nowden L, Lash R, Bass AJ, Stachler MD. Abnormal TP53 Predicts Risk of Progression in Patients With Barrett's Esophagus Regardless of a Diagnosis of Dysplasia. Gastroenterology 2022; 162:468-481. [PMID: 34757142 PMCID: PMC9341495 DOI: 10.1053/j.gastro.2021.10.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma. A major challenge is identifying the small group with BE who will progress to advanced disease from the many who will not. Assessment of p53 status has promise as a predictive biomarker, but analytic limitations and lack of validation have precluded its use. The aim of this study was to develop a robust criteria for grading abnormal immunohistochemical (IHC) expression of p53 and to test its utility as a biomarker for progression in BE. METHODS Criteria for abnormal IHC of p53 were developed in BE biopsies and validated with sequencing to assess TP53 mutations. The utility of p53 IHC as a biomarker for progression of BE was tested retrospectively in 561 patients with BE with or without known progression. The findings were prospectively validated in a clinical practice setting in 1487 patients with BE. RESULTS Abnormal p53 IHC highly correlated with TP53 mutation status (90.6% agreement) and was strongly associated with neoplastic progression in the retrospective cohorts, regardless of histologic diagnosis (P < .001). In the retrospective cohort, abnormal p53 was associated with a hazard ratio of 5.03 (95% confidence interval, 3.88-6.5) and a hazard ratio of 5.27 (95% confidence interval, 3.93-7.07) for patients with exclusively nondysplastic disease before progression. In the prospective validation cohort, p53 IHC predicted progression among nondysplastic BE, indefinite for dysplasia, and low-grade dysplasia (P < .001). CONCLUSIONS p53 IHC identifies patients with BE at higher risk of progression, including in patients without evidence of dysplasia. p53 IHC is inexpensive, easily integrated into routine practice, and should be considered in biopsies from all BE patients without high-grade dysplasia or cancer.
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Affiliation(s)
- Mark Redston
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Anthony Kim
- Department of Molecular Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Fahire G. Akarca
- Department of Molecular Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Marianne Rara
- Department of Pathology, University of California San Francisco, San Francisco, California
| | | | | | | | - Adam J. Bass
- Department of Molecular Oncology, Dana Farber Cancer Institute, Boston, Massachusetts,Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Matthew D. Stachler
- Department of Pathology, University of California San Francisco, San Francisco, California
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Stier MW, Lodhia N, Jacobs J, Nozicka D, Kavitt R, Siddiqui U, Waxman I, Konda VJ. Perceptions of risk and therapy among patients with Barrett's esophagus: a patient survey study. Dis Esophagus 2018; 31:4209493. [PMID: 29036278 DOI: 10.1093/dote/dox109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
Nondysplastic Barrett's esophagus has a risk of progression to esophageal adenocarcinoma as low as 0.18-0.3% per person per year, and low-grade dysplasia as low as 0.5%. While adherence to guidelines and selection of management options varies, little is known about what modifies patient decision-making. This study aims to evaluate and identify factors that influence patient perceptions of risk and decisions about management. An independently developed and piloted survey was administered to patients at an academic hospital. Risk perception and desire for therapy were assessed using a standard reference gamble paradigm, and responses were stratified based on patient and disease characteristics. Data were analyzed with Student's t and chi-squared tests. A total of 42 of 50 patients with Barrett's esophagus and no prior endoscopic therapy participated (84% response; 76% nondysplastic Barrett's esophagus, 22% low-grade dysplasia, 2% indeterminate for dysplasia; mean age 61 years, 29% female). On average, patients perceived their risk of developing esophageal adenocarcinoma in the next year, 10 years and lifetime as 6, 14, and 19%, respectively. Nearly half viewed their lifetime risk of developing esophageal adenocarcinoma to be the same or higher than diabetes, heart disease, or colon cancer. Although 92% of patients felt surveillance beneficial, only 54% believed endoscopic therapy to be effective in most or all cases. As many as 83% of patients were willing to undergo endoscopic therapy with a hypothetical success rate as low as 70%, and a majority (64%) accepted complication rates up to 30%. Compared to patients with low risk perception of developing esophageal adenocarcinoma, those with high risk perception more often believed their risk for developing esophageal adenocarcinoma was greater than diabetes (p = 0.04) or colon cancer (p = 0.002). Those with lifetime low risk perception were less likely to accept modest complication rates (<10%) of therapy (P < 0.05). Age, gender, degree of dysplasia, lifetime endoscopies and duration of symptoms had no impact on perceived effectiveness of surveillance or therapy, and did not correlate with desire for treatment at varying levels of risk and effectiveness. Patients with Barrett's esophagus overestimate their risk of developing esophageal adenocarcinoma and will accept low success rates and high risk of complications to undergo endoscopic therapy. Baseline risk perception correlates with the desire for endoscopic therapy.
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Affiliation(s)
- M W Stier
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - N Lodhia
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - J Jacobs
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - D Nozicka
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - R Kavitt
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - U Siddiqui
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - I Waxman
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
| | - V J Konda
- Division of Gastroenterology, Department of Internal Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
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