Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts

OCCAMS Consortium

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1720-1728.e4
JournalGastroenterology
Volume155
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Barrett Esophagus
Metaplasia
Adenocarcinoma
Phenotype
Neoplasms
Survival

Keywords

  • Barrett Esophagus
  • Esophageal Adenocarcinoma
  • Esophagus
  • Survival

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts. / OCCAMS Consortium.

In: Gastroenterology, Vol. 155, No. 6, 01.12.2018, p. 1720-1728.e4.

Research output: Contribution to journalArticle

@article{2b8b84827f024c779484c77282376510,
title = "Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts",
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.",
keywords = "Barrett Esophagus, Esophageal Adenocarcinoma, Esophagus, Survival",
author = "{OCCAMS Consortium} and Tarek Sawas and Sarah Killcoyne and Iyer, {Prasad G} and Wang, {Kenneth Ke Ning} and Smyrk, {Thomas Christopher} and Kisiel, {John B} and Yi Qin and Ahlquist, {David A.} and Rustgi, {Anil K.} and Costa, {Rui J.} and Moritz Gerstung and Fitzgerald, {Rebecca C.} and Katzka, {David A} and Ayesha Noorani and Edwards, {Paul A.W.} and Nicola Grehan and Barbara Nutzinger and Caitriona Hughes and Elwira Fidziukiewicz and Jan Bornschein and Shona MacRae and Jason Crawte and Gianmarco Contino and Xiaodun Li and Rue, {Rachel de la} and Maria O'Donovan and Ahmad Miremad and Shalini Malhotra and Monika Tripathi and Simon Tavar{\'e} and Lynch, {Andy G.} and Matthew Eldridge and Maria Secrier and Lawrence Bower and Ginny Devonshire and Juliane Perner and Sriganesh Jammula and Jim Davies and Charles Crichton and Nick Carroll and Peter Safranek and Andrew Hindmarsh and Vijayendran Sujendran and Hayes, {Stephen J.} and Yeng Ang and Preston, {Shaun R.} and Sarah Oakes and Izhar Bagwan and Vicki Save and Skipworth, {Richard J.E.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1053/j.gastro.2018.08.036",
language = "English (US)",
volume = "155",
pages = "1720--1728.e4",
journal = "Gastroenterology",
issn = "0016-5085",
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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 Ke Ning

AU - Smyrk, Thomas Christopher

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.

PY - 2018/12/1

Y1 - 2018/12/1

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

VL - 155

SP - 1720-1728.e4

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

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