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Cancer Epidemiol Biomarkers Prev. 2016 May;25(5):727-35. doi: 10.1158/1055-9965.EPI-15-0832. Epub 2016 Feb 29.

Predicting Barrett's Esophagus in Families: An Esophagus Translational Research Network (BETRNet) Model Fitting Clinical Data to a Familial Paradigm.

Author information

1
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.
2
Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
3
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
4
Clinical Research Division, Fred Hutchinson Cancer Research Center and Gastroenterology Division, University of Washington School of Medicine, Seattle, Washington.
5
Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Division of Gastroenterology and Hepatology, Louis Stokes Veterans Administration Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
6
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska.
7
Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
8
Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
9
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.
10
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
11
Department of Medicine, Columbia University Medical Center, New York, New York.
12
Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
13
Division of General Medical Sciences (Oncology), Case Comprehensive Cancer Center, Cleveland, Ohio.
14
Department of Medicine and Case Comprehensive Cancer Center, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
15
Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
16
Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Amitabh.Chak@uhhospitals.org.

Abstract

BACKGROUND:

Barrett's esophagus is often asymptomatic and only a small portion of Barrett's esophagus patients are currently diagnosed and under surveillance. Therefore, it is important to develop risk prediction models to identify high-risk individuals with Barrett's esophagus. Familial aggregation of Barrett's esophagus and esophageal adenocarcinoma, and the increased risk of esophageal adenocarcinoma for individuals with a family history, raise the necessity of including genetic factors in the prediction model. Methods to determine risk prediction models using both risk covariates and ascertained family data are not well developed.

METHODS:

We developed a Barrett's Esophagus Translational Research Network (BETRNet) risk prediction model from 787 singly ascertained Barrett's esophagus pedigrees and 92 multiplex Barrett's esophagus pedigrees, fitting a multivariate logistic model that incorporates family history and clinical risk factors. The eight risk factors, age, sex, education level, parental status, smoking, heartburn frequency, regurgitation frequency, and use of acid suppressant, were included in the model. The prediction accuracy was evaluated on the training dataset and an independent validation dataset of 643 multiplex Barrett's esophagus pedigrees.

RESULTS:

Our results indicate family information helps to predict Barrett's esophagus risk, and predicting in families improves both prediction calibration and discrimination accuracy.

CONCLUSIONS:

Our model can predict Barrett's esophagus risk for anyone with family members known to have, or not have, had Barrett's esophagus. It can predict risk for unrelated individuals without knowing any relatives' information.

IMPACT:

Our prediction model will shed light on effectively identifying high-risk individuals for Barrett's esophagus screening and surveillance, consequently allowing intervention at an early stage, and reducing mortality from esophageal adenocarcinoma. Cancer Epidemiol Biomarkers Prev; 25(5); 727-35. ©2016 AACR.

PMID:
26929243
PMCID:
PMC4873373
DOI:
10.1158/1055-9965.EPI-15-0832
[Indexed for MEDLINE]
Free PMC Article

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