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.
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.
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.
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.
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).