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Long-term follow-up of malignancy biomarkers in patients with Barrett's esophagus undergoing medical or surgical treatment.

AbstractOBJECTIVE:
This study aims to compare some validated biomarkers of malignancy (Ki-67, p53, and apoptosis) between 2 groups of patients with Barrett's esophagus (BE) undergoing randomly medical or surgical treatment.
BACKGROUND:
The treatment of choice to prevent the malignant progression of BE remains controversial. Translational studies using biomarkers associated with the metaplasia-tumor pathway could be useful to provide some information in this regard.
METHODS:
The study group consisted of 45 patients: 20 under medical treatment with 40 mg/day of proton pump inhibitors (PPIs) and 25 after Nissen fundoplication (NFP). After a median follow-up of 8 years (range, 5-10 years), the values of Ki-67, p53, and apoptosis were analyzed in all patients before treatment (n = 45) and then 1 year (n = 45), 3 years (n = 45), 5 years (n = 45), and 10 years (n = 25) afterwards in both groups of treatment. These values were also analyzed in 2 subgroups of patients with successful medical and surgical treatment.
RESULTS:
Both Ki-67 and p53 remained stable after NFP, whereas they increased progressively in patients under PPIs with statistically significant differences between the 2 groups. Conversely, the apoptotic index increased progressively after NFP and decreased in the patients under PPIs with significant differences at 3, 5, and 10 years of follow-up. On comparing the subgroups of successful treatment the same differences were found.
CONCLUSIONS:
Barrett's epithelium remains more stable after a long-term follow-up in patients with BE treated surgically than in those under PPIs even in the absence of abnormal rates of acid reflux.
AuthorsLuisa F Martinez de Haro, Angeles Ortiz, Pascual Parrilla, Vicente Munitiz, Carlos M Martinez, Beatriz Revilla, David Ruiz de Angulo, Juan Bermejo, Jose Yélamos, Joaquin Molina
JournalAnnals of surgery (Ann Surg) Vol. 255 Issue 5 Pg. 916-21 (May 2012) ISSN: 1528-1140 [Electronic] United States
PMID22415421 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Biomarkers, Tumor
  • Ki-67 Antigen
  • Proton Pump Inhibitors
  • Tumor Suppressor Protein p53
Topics
  • Adolescent
  • Adult
  • Aged
  • Apoptosis
  • Barrett Esophagus (drug therapy, metabolism, pathology, surgery)
  • Biomarkers, Tumor (metabolism)
  • Disease Progression
  • Esophageal Neoplasms (prevention & control)
  • Female
  • Follow-Up Studies
  • Fundoplication
  • Humans
  • Ki-67 Antigen (metabolism)
  • Male
  • Middle Aged
  • Proton Pump Inhibitors (therapeutic use)
  • Tumor Suppressor Protein p53 (metabolism)
  • Young Adult

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