Objective: 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.
Some validated biomarkers of malignancy (Ki-67, p53, and apoptosis) were compared between 2 groups of patients with Barrett's esophagus undergoing medical or surgical treatment. The results showed that Barrett's epithelium tends to remain more stable after a long-term follow-up in patients following antireflux surgery than in patients under medical therapy.
*Department of Surgery
†Research Unit of Experimental Surgery
‡Department of Pathology
§Department of Immunology, Cancer Research Program, IMIM-Hospital del Mar, CIBERehd, Barcelona, Spain
‖Endoscopy Unit University Hospital V Arrixaca, CIBERehd, Murcia, Spain.
Reprints: Pascual Parrilla, MD, PhD, Department of Surgery, University Hospital V, Arrixaca, El Palmar. 30120-Murcia, Spain. E-mail: firstname.lastname@example.org.
Disclosure: This work has been supported by grants from the FIS (Fondo de Investigaciones Sanitarias) (PI09/1808), Fundación Mutua Madrileña and Fundación Séneca (08823/PI/08).