Gastric (Foveolar)-Type Dysplasia in Barrett's Esophagus: A Clinical, Molecular, and Long-Term Outcome Study.

Abstract

The aim of this long-term progression study was to evaluate the clinical and pathologic features of gastric type dysplasia in Barrett's esophagus (BE). Baseline biopsies from 208 patients with BE from the Seattle prospective cohort were evaluated for the type (gastric or intestinal) and grade of dysplasia. Twenty-seven patients progressed to cancer and 181 did not over the long-term follow-up period. Patients with gastric or intestinal dysplasia were compared with each other regarding their flow cytometric DNA content abnormalities and progression rates to cancer. Of the 59 patients with dysplasia at baseline, 12 (20%) had gastric-type dysplasia only, 24 (41%) had mixed gastric- and intestinal-type dysplasia, and 23 (39%) had intestinal-type dysplasia only. Patients with any gastric-type dysplasia component (alone or mixed with intestinal-type dysplasia) showed a significantly higher rate of high-grade dysplasia (72% vs 23%, P < 0.001) at baseline and cancer development (47% vs 22%, P = 0.05), and a significantly shorter time frame to cancer development (32 vs 64 months, P = 0.008), as well as a longer BE segment length ( P = 0.05), and higher rate of aneuploidy ( P = 0.04), compared with patients with pure intestinal dysplasia. By multivariable analysis, gastric-type dysplasia showed a higher hazard ratio of progression to cancer compared with patients with intestinal-type dysplasia. Gastric-type dysplasia is common in BE. Our study suggests that this type of dysplasia may represent a more aggressive form of neoplastic precursor than conventional intestinal-type dysplasia.