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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 publication

DOI

10.1053/j.gastro.2018.08.036

Type

Journal article

Journal

Gastroenterology

Publication Date

12/2018

Volume

155

Pages

1720 - 1728.e4

Addresses

Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Keywords

OCCAMS Consortium, Intestines, Esophagus, Humans, Adenocarcinoma, Esophageal Neoplasms, Barrett Esophagus, Metaplasia, Neoplasm Staging, Prognosis, Proportional Hazards Models, Regression Analysis, Phenotype, Aged, Middle Aged, United States, Male, United Kingdom