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Published on: July 20, 2014
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Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual
Pauline A Zellenrath1, Laurelle van Tilburg1, Roos E Pouw2
1Division of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
Summary
Females with Barrett's esophagus have a lower risk of neoplastic progression than males. However, sex differences in progression risk and time to progression are smaller than previously thought.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Barrett's esophagus (BE) carries a risk of neoplastic progression.
- Previous studies suggest females have a lower risk of progression than males.
- Robust, large-scale analyses of sex-based risk in BE are limited.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of individual patient data (IPD).
- To provide robust evidence on neoplastic progression risk in females with BE.
- To compare neoplastic progression risk between sexes in BE patients.
Main Methods:
- Systematic literature search of Medline, Embase, and Google Scholar databases.
- Inclusion of studies reporting original data on progression from BE to high-grade dysplasia or esophageal adenocarcinoma.
- Quality control of IPD and multivariable Cox regression analysis to assess the association between sex and progression risk.
Main Results:
- IPD from 11 studies included 2196 females (31%).
- Females exhibited a lower neoplastic progression risk (HR for males vs. females: 1.44; 95% CI: 1.13-1.82), adjusted for covariates.
- Annual progression rates were 0.88% in females and 1.29% in males; time to progression was similar.
Conclusions:
- While females have a lower risk, the sex difference in neoplastic progression for BE is smaller than previously reported.
- Time to progression to high-grade dysplasia or adenocarcinoma is similar between sexes.
- Future research should explore factors beyond sex for risk stratification in BE patients.
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