High‐resolution genomic alterations in Barrett's metaplasia of patients who progress to esophageal dysplasia and adenocarcinoma

The main risk factor for esophageal dysplasia and adenocarcinoma (DAC) is Barrett’s esophagus (BE), characterized by intestinal metaplasia. The critical genomic mechanisms that lead to progression of non-dysplastic BE to DAC remain poorly understood and require analyses of longitudinal patient cohorts and high-resolution assays. We tested BE tissues from 74 patients, including 42 non-progressors from two separate groups of 21 patients each, and 32 progressors (16 in a longitudinal cohort before DAC/pre-progression-BE, and 16 with temporally concurrent but spatially separate DAC/concurrent-BE). We interrogated genome-wide somatic copy number alterations (SCNAs) at the exon level with high-resolution SNP arrays in DNA from formalin-fixed samples histologically confirmed as non-dysplastic BE. The most frequent abnormalities were SCNAs involving FHIT exon 5, CDKN2A/B, or both in 88% longitudinal BE progressors to DAC vs. 24% in both non-progressor groups (P=0.0004). Deletions in other genomic regions were found in 56% of pre-progression-BE but only in 1 non-progressor-BE (P=0.0004). SCNAs involving FHIT exon 5 and CDKN2A/B were also frequently detected in BE temporally concurrent with DAC. TP53 losses were detected in concurrent-BE but not earlier in pre-progression-BE tissues of patients who developed DAC. CDKN2A/p16 immunohistochemistry showed significant loss of expression in BE of progressors vs. non-progressors, supporting the genomic data. Our data suggest a role for CDKN2A/B and FHIT in early progression of BE to dysplasia and adenocarcinoma that warrants future mechanistic research. Alterations in CDKN2A/B and FHIT by high-resolution assays may serve as biomarkers of increased risk of progression to DAC when detected in BE tissues.