Prior Diagnosis of Barrett’s Esophagus Is Infrequent, but Associated with Improved Esophageal Adenocarcinoma Survival
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Efforts to reduce mortality from esophageal adenocarcinoma (EA) have focused on screening and surveillance of Barrett’s esophagus (BE).
We sought to determine the frequency of prior diagnosis of BE in patients with EA and to evaluate the impact of a prior BE diagnosis on mortality in EA patients.
This was a retrospective cohort study of patients diagnosed with EA in the VA during 2002–2016. We compared the distributions of EA stage and receipt of treatment between EA patients with and without a prior BE diagnosis and used Cox proportional hazards models to compare mortality risk (all-cause and cancer specific) unadjusted and adjusted for stage and treatment to assess their impact on any survival differences.
Among 8564 EA patients, only 4.9% had a prior BE diagnosis. The proportion with prior BE diagnosis increased from 3.2% in EA patients diagnosed during 2005–2007 to 7.0% in those diagnosed during 2014–2016. EA patients with a prior BE diagnosis were more likely to have stage 1 disease and receive any treatment. A prior BE diagnosis was associated with lower all-cause mortality risk (hazard ratio [HR] unadjusted for stage, 0.69; 95% CI, 0.61–0.80), which was largely explained by the earlier stage of EA at the time of diagnosis (HR adjusted for stage, 0.87; 95% CI, 0.75–0.99). There was no evidence of lead time bias or length time bias.
Prior diagnosis of BE was associated with better survival, largely due to earlier EA stage at diagnosis.
KeywordsEsophageal neoplasms Surveillance Incidence Mortality
Gastroesophageal reflux disease
APT involved in study concept and design. Statistical analysis and interpretation of data were carried out by TN, MCT, YL, HES and APT. APT involved in data acquisition and obtained funding. YL prepared data. Drafting of the manuscript was performed by TN and APT. Critical review of the manuscript for important intellectual content was done by TN, MCT, YL, HES and APT. The study was supervised by APT. All authors read and approved the final version for submission.
This work was supported in part by National Institutes of Health grant P30 DK056338 (Study Design and Clinical Research Core), which supports the Texas Medical Center Digestive Diseases Center. Hashem El-Serag is also supported by NIDDK K24-04-107. This research was supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government or Baylor College of Medicine.
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Conflict of interest
All authors declare that they have no conflict of interest.
- 13.SEER. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2016 Sub (1973-2014) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total US, 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2017, based on the November 2016 submission.