Development and External Validation of a Model to Predict Complex Treatment After Radiofrequency Ablation for Barrett's Esophagus With Early Neoplasia
van Munster, Sanne N.; Nieuwenhuis, Esther; Bisschops, Raf; Willekens, Hilde; Weusten, Bas L.A.M.; Herrero, Lorenza Alvarez; Bogte, Auke; Alkhalaf, Alaa; Schenk, Ed B.E.; Schoon, Erik J.; Curvers, Wouter; Koch, Arjun D.; de Jonge, Pieter Jan F.; Tang, Tjon J.; Nagengast, Wouter B.; Westerhof, Jessie; Houben, Martin H.M.G.; Bergman, Jacques J.G.H.M.; Pouw, Roos E.
(2022) Clinical Gastroenterology and Hepatology, volume 20, issue 11, pp. 2495 - 2504.e5
(Article)
Abstract
Background & Aims: Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is safe and leads to complete eradication in the majority of patients. However, a subgroup will experience a more complex treatment course with a risk for failure or disease progression. Early identification of these patients may improve patient counseling
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and treatment outcomes. We aimed to develop a prognostic model for a complex treatment course. Methods: We collected data from a nationwide registry that captures outcomes for all patients undergoing endoscopic eradication therapy for early BE neoplasia. A complex treatment course was defined as neoplastic progression, treatment failure, or the need for endoscopic resection during the radiofrequency ablation treatment phase. We developed a prognostic model using logistic regression. We externally validated our model in an independent registry. Results: A total of 1386 patients were included, of whom 78 (6%) had a complex treatment course. Our model identified patients with a BE length of 9 cm or longer with a visible lesion containing high-grade dysplasia/cancer, and patients with less than 50% squamous conversion after radiofrequency ablation were identified as high risk for a complex treatment. This applied to 8% of the study population and included 93% of all treatment failures and 76% of all patients with advanced neoplastic progression. The model appeared robust in multiple sensitivity analyses and performed well in external validation (area under the curve, 0.84). Conclusions: We developed a prognostic model that identified patients with a BE length of 9 cm or longer and high-grade dysplasia/esophageal adenocarcinoma and those with poor squamous regeneration as high risk for a complex treatment course. The good performance in external validation suggests that it may be used in clinical management (Netherlands Trial Register: NL7039).
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Keywords: Barrett's Esophagus, Endoscopic Therapy, Esophageal Adenocarcinoma, Gastroenterology, Hepatology, Journal Article
ISSN: 1542-3565
Publisher: W.B. Saunders Ltd
Note: Funding Information: Sanne van Munster (Conceptualization: Equal; Data curation: Equal; Formal analysis: Lead; Investigation: Equal; Methodology: Equal; Project administration: Equal; Validation: Equal; Writing – original draft: Lead), Esther Nieuwenhuis (Data curation: Equal; Formal analysis: Equal; Project administration: Lead; Writing – review & editing: Equal), R. Bisschops (Data curation: Equal; Methodology: Equal; Supervision: Equal; Writing – review & editing: Equal), H. Willekens (Data curation: Equal; Writing – review & editing: Equal), Bas L. A. M. Weusten (Conceptualization: Equal; Data curation: Equal; Methodology: Equal; Supervision: Equal; Writing – review & editing: Equal), Lorenza Alvarez Herrero (Data curation: Equal; Writing – review & editing: Equal), Auke Bogte (Data curation: Equal; Writing – review & editing: Equal), Alaa Alkhalaf (Data curation: Equal; Writing – review & editing: Equal), B. E. Schenk (Data curation: Equal; Writing – review & editing: Equal), Erik J. Schoon (Data curation: Equal; Writing – review & editing: Equal), Wouter Curvers (Data curation: Equal; Writing – review & editing: Equal), Arjun D. Koch (Data curation: Equal; Writing – review & editing: Equal), Pieter Jan F. de Jonge (Data curation: Equal; Writing – review & editing: Equal), Tjon J. Tang (Data curation: Equal; Writing – review & editing: Equal), Wouter B. Nagengast (Data curation: Equal; Formal analysis: Equal; Methodology: Equal; Writing – review & editing: Equal), Jessie Westerhof (Data curation: Equal; Writing – review & editing: Equal), Martin H. M. G. Houben (Data curation: Equal; Writing – review & editing: Equal), Jacques J. G. H. M. Bergman, MD, PhD (Conceptualization: Lead; Data curation: Equal; Formal analysis: Equal; Methodology: Lead; Validation: Equal; Writing – review & editing: Lead), Roos E. Pouw (Conceptualization: Equal; Data curation: Equal; Formal analysis: Equal; Methodology: Equal; Supervision: Lead; Writing – review & editing: Lead) Publisher Copyright: © 2022 The Authors
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