Abstract:
BACKGROUND & AIMS:Most patients with esophageal adenocarcinoma (EAC) present with de novo tumors. Although this could be due to inadequate screening strategies, the precise reason for this observation is not clear. We compared survival of patients with prevalent EAC with and without synchronous Barrett esophagus (BE) with intestinal metaplasia (IM) at the time of EAC diagnosis. METHODS:Clinical data were studied using Cox proportional hazards regression to evaluate the effect of synchronous BE-IM on EAC survival independent of age, sex, TNM stage, and tumor location. We analyzed data from a cohort of patients with EAC from the Mayo Clinic (n=411; 203 with BE and IM) and a multicenter cohort from the United Kingdom (n=1417; 638 with BE and IM). RESULTS:In the Mayo cohort, BE with IM had a reduced risk of death compared to patients without BE and IM (hazard ratio [HR] 0.44; 95% CI, 0.34-0.57; P<.001). In a multivariable analysis, BE with IM was associated with longer survival independent of patient age or sex, tumor stage or location, and BE length (adjusted HR, 0.66; 95% CI, 0.5-0.88; P=.005). In the United Kingdom cohort, patients BE and IM had a reduced risk of death compared with those without (HR, 0.59; 95% CI, 0.5-0.69; P<.001), with continued significance in multivariable analysis that included patient age and sex and tumor stage and tumor location (adjusted HR, 0.77; 95% CI, 0.64-0.93; P=.006). CONCLUSION:Two types of EAC can be characterized based on the presence or absence of BE. These findings could increase our understanding the etiology of EAC, and be used in management and prognosis of patients.
journal_name
Gastroenterologyjournal_title
Gastroenterologyauthors
Sawas T,Killcoyne S,Iyer PG,Wang KK,Smyrk TC,Kisiel JB,Qin Y,Ahlquist DA,Rustgi AK,Costa RJ,Gerstung M,Fitzgerald RC,Katzka DA,OCCAMS Consortium.doi
10.1053/j.gastro.2018.08.036subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1720-1728.e4issue
6eissn
0016-5085issn
1528-0012pii
S0016-5085(18)34923-0journal_volume
155pub_type
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