| Source: |
Laun, S E, Kann, L, Braun, J, Gilbert, S, Lunz, D, Pierre, F, Kalra, A, Ma, K, Tsai, H L, Wang, H, Jit, S, Cheng, Y, Ahmed, Y, Wang, K K, Leggett, C L, Cellini, A, Ioffe, O B, Zaidi, A H, Omstead, A N, Jobe, B, Korman, L, Cornish, D, Zellenrath, P, Spaander, M, Kuipers, E, Perpetua, L, Greenwald, B D, Maddala, T & Meltzer, S J 2025, 'Validation of an Epigenetic Prognostic Assay to Accurately Risk-Stratify Patients with Barrett Esophagus', American Journal of Gastroenterology, vol. 120, no. 6, 3030, pp. 1296-1306. https://doi.org/10.14309/ajg.0000000000003030 |
| Description: |
INTRODUCTION: Esophageal adenocarcinoma (EAC) is the second-most lethal cancer in the United States, with Barrett esophagus (BE) being the strongest risk factor. Assessing the future risk of neoplastic progression in patients with BE is difficult; however, high-grade dysplasia (HGD) and early EAC are treatable by endoscopic eradication therapy (EET), with survival rates of 90%. Thus, it would be beneficial to develop a molecular assay to identify high-risk patients, who merit more frequent endoscopic surveillance or EET, as well as low-risk patients, who can avoid EET and undergo less frequent surveillance. METHODS: Deidentified endoscopic biopsies were acquired from 240 patients with BE at 6 centers and confirmed as future progressors or nonprogressors. Tissues were analyzed by a set of methylation-specific biomarker assays. Test performance was assessed in an independent validation set using 4 stratification levels: low risks, low-moderate risks, high-moderate risks, and high risks. RESULTS: Relative to patients in the low-risk group, high-risk patients were 15.2 times more likely to progress within 5 years to HGD or EAC. For patients in the high-risk category, the average risk of progressing to HGD or EAC within 5 years was 21.5%, 4-fold the BE population prevalence within 5 years, whereas low-risk patients had a progression risk of only 1.85%. DISCUSSION: This clinical assay, Esopredict, stratifies future neoplastic progression risk to identify higher-risk patients with BE who can benefit from EET or more frequent surveillance and lower-risk patients who can benefit from reduced surveillance. |