RT Journal Article
SR Electronic
T1 Computational modelling suggests that Barrett’s oesophagus may be the precursor of all oesophageal adenocarcinomas
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1435
OP 1440
DO 10.1136/gutjnl-2020-321598
VO 70
IS 8
A1 Curtius, Kit
A1 Rubenstein, Joel H
A1 Chak, Amitabh
A1 Inadomi, John M
YR 2021
UL http://gut.bmj.com/content/70/8/1435.abstract
AB Objective Barrett’s oesophagus (BE) is a known precursor to oesophageal adenocarcinoma (OAC) but current clinical data have not been consolidated to address whether BE is the origin of all incident OAC, which would reinforce evidence for BE screening efforts. We aimed to answer whether all expected prevalent BE, diagnosed and undiagnosed, could account for all incident OACs in the US cancer registry data.Design We used a multiscale computational model of OAC that includes the evolutionary process from normal oesophagus through BE in individuals from the US population. The model was previously calibrated to fit Surveillance, Epidemiology and End Results cancer incidence curves. Here, we also utilised age-specific and sex-specific US census data for numbers at-risk. The primary outcome for model validation was the expected number of OAC cases for a given calendar year. Secondary outcomes included the comparisons of resulting model-predicted prevalence of BE and BE-to-OAC progression to the observed prevalence and progression rates.Results The model estimated the total number of OAC cases from BE in 2010 was 9970 (95% CI: 9140 to 11 980), which recapitulates nearly all OAC cases from population data. The model simultaneously predicted 8%–9% BE prevalence in high-risk males age 45–55, and 0.1%–0.2% non-dysplastic BE-to-OAC annual progression in males, consistent with clinical studies.Conclusion There are likely few additional OAC cases arising in the US population outside those expected from individuals with BE. Effective screening of high-risk patients could capture the majority of population destined for OAC progression and potentially decrease mortality through early detection and curative removal of small (pre)cancers during surveillance.All data relevant to the study are included in the article or uploaded as Supplementary material. All data used in our analysis are publicly available. CORI data can be accessed through application with ethical approval to NIDDK (https://niddkrepository.org/studies/cori/). All equations are provided either in Figures and Supplementary material or were previously published along with model parameters. Code to solve equations was developed in R (V.3.6.1). Computational scripts are available at: github.com/yosoykit/BEtoEAC_Results.