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Segment Length and Risk for Neoplastic Progression in Patients with Barrett Esophagus
- Rebecca E. Rudolph, MD, MPH;
- Thomas L. Vaughan, MD, MPH; and
- Barry Storer, PhD
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IN RESPONSE:
Assessment of confounding in these analyses was relatively straightforward because none of the risk factors that we examined, with the exception of histologic diagnosis at baseline, was associated to an important degree with both risk for neoplastic progression and segment length at baseline. After it was clear that histologic diagnosis at baseline was a confounder, we evaluated the effects of other potential risk factors by inserting them one or two at a time into a model that also included segment length and histologic diagnosis at baseline. None of these factors was observed to change the relative risk estimate for segment length to an important degree; thus, they were not included in the final models. We did not evaluate all the potential confounders in a single model and do not make any statements to that effect. Multivariate analyses with larger numbers of independent variables would not have been very meaningful given the relatively small number of events in some analyses.
Although our study is the largest yet to examine the relation between segment length and risk for neoplastic progression in patients with Barrett esophagus, we agree that additional follow-up of our cohort and other similar cohorts is needed to measure more precisely any excess risk associated with long segments. Indeed, we made several comments to this effect in the Discussion section. We believe that our conclusion, that the risk for esophageal adenocarcinoma in patients with short-segment Barrett esophagus is not substantially lower than that in patients with longer segments, is appropriately conservative.
Rebecca E. Rudolph, MD, MPH
Thomas L. Vaughan, MD, MPH
Barry Storer, PhD
Fred Hutchinson Cancer Research Center; Seattle, WA 98109-1024
- Copyright ©2004 by the American College of Physicians
