TY - JOUR
T1 - Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts
AU - OCCAMS Consortium
AU - Sawas, Tarek
AU - Killcoyne, Sarah
AU - Iyer, Prasad G.
AU - Wang, Kenneth K.
AU - Smyrk, Thomas C.
AU - Kisiel, John B.
AU - Qin, Yi
AU - Ahlquist, David A.
AU - Rustgi, Anil K.
AU - Costa, Rui J.
AU - Gerstung, Moritz
AU - Fitzgerald, Rebecca C.
AU - Katzka, David A.
AU - Noorani, Ayesha
AU - Edwards, Paul A.W.
AU - Grehan, Nicola
AU - Nutzinger, Barbara
AU - Hughes, Caitriona
AU - Fidziukiewicz, Elwira
AU - Bornschein, Jan
AU - MacRae, Shona
AU - Crawte, Jason
AU - Contino, Gianmarco
AU - Li, Xiaodun
AU - Rue, Rachel de la
AU - O'Donovan, Maria
AU - Miremad, Ahmad
AU - Malhotra, Shalini
AU - Tripathi, Monika
AU - Tavaré, Simon
AU - Lynch, Andy G.
AU - Eldridge, Matthew
AU - Secrier, Maria
AU - Bower, Lawrence
AU - Devonshire, Ginny
AU - Perner, Juliane
AU - Jammula, Sriganesh
AU - Davies, Jim
AU - Crichton, Charles
AU - Carroll, Nick
AU - Safranek, Peter
AU - Hindmarsh, Andrew
AU - Sujendran, Vijayendran
AU - Hayes, Stephen J.
AU - Ang, Yeng
AU - Preston, Shaun R.
AU - Oakes, Sarah
AU - Bagwan, Izhar
AU - Save, Vicki
AU - Skipworth, Richard J.E.
N1 - Publisher Copyright:
© 2018 AGA Institute
PY - 2018/12
Y1 - 2018/12
N2 - 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.
AB - 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.
KW - Barrett Esophagus
KW - Esophageal Adenocarcinoma
KW - Esophagus
KW - Survival
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U2 - 10.1053/j.gastro.2018.08.036
DO - 10.1053/j.gastro.2018.08.036
M3 - Article
C2 - 30165050
AN - SCOPUS:85057552199
SN - 0016-5085
VL - 155
SP - 1720-1728.e4
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -