Skip to main content

Advertisement

SpringerLink
Log in

Prior Diagnosis of Barrett’s Esophagus Is Infrequent, but Associated with Improved Esophageal Adenocarcinoma Survival

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Efforts to reduce mortality from esophageal adenocarcinoma (EA) have focused on screening and surveillance of Barrett’s esophagus (BE).

Aims

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.

Methods

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.

Results

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.

Conclusions

Prior diagnosis of BE was associated with better survival, largely due to earlier EA stage at diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BE:

Barrett’s esophagus

CI:

Confidence interval

EA:

Esophageal adenocarcinoma

GERD:

Gastroesophageal reflux disease

HR:

Hazard ratio

OR:

Odds ratio

References

  1. Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol. 2012;23:3155–3162.

    Article  CAS  Google Scholar 

  2. Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer. 2013;119:1149–1158.

    Article  Google Scholar 

  3. Vaughan TL, Fitzgerald RC. Precision prevention of oesophageal adenocarcinoma. Nat Rev Gastroenterol Hepatol. 2015;12:243–248.

    Article  Google Scholar 

  4. Thrift AP. The epidemic of oesophageal carcinoma: where are we now? Cancer Epidemiol. 2016;41:88–95.

    Article  Google Scholar 

  5. Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–e52.

    Article  Google Scholar 

  6. Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.

    Article  CAS  Google Scholar 

  7. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.

    Article  Google Scholar 

  8. Whiteman DC, Appleyard M, Bahin FF, et al. Australian clinical practice guidelines for the diagnosis and management of Barrett’s esophagus and early esophageal adenocarcinoma. J Gastroenterol Hepatol. 2015;30:804–820.

    Article  Google Scholar 

  9. Dulai GS, Guha S, Kahn KL, et al. Preoperative prevalence of Barrett’s esophagus in esophageal adenocarcinoma: a systematic review. Gastroenterology. 2002;122:26–33.

    Article  Google Scholar 

  10. Cooper GS, Kou TD, Chak A. Receipt of previous diagnoses and endoscopy and outcome from esophageal adenocarcinoma: a population-based study with temporal trends. Am J Gastroenterol. 2009;104:1356–1362.

    Article  Google Scholar 

  11. Cook MB, Drahos J, Wood S, et al. Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett’s oesophagus. Br J Cancer. 2016;115:1383–1390.

    Article  CAS  Google Scholar 

  12. Tramontano AC, Sheehan DF, Yeh JM, et al. The impact of a prior diagnosis of Barrett’s esophagus on esophageal adenocarcinoma survival. Am J Gastroenterol. 2017;112:1256–1264.

    Article  Google Scholar 

  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.

  14. Bhat SK, McManus DT, Coleman HG, et al. Oesophageal adenocarcinoma and prior diagnosis of Barrett’s oesophagus: a population-based study. Gut. 2015;64:20–25.

    Article  Google Scholar 

  15. Corley DA, Mehtani K, Quesenberry C, et al. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology. 2013;145:312–319.

    Article  Google Scholar 

  16. El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65:1252–1260.

    Article  Google Scholar 

  17. Zullig LL, Jackson GL, Dorn RA, et al. Cancer incidence among patients of the US Veterans Affairs Health Care System. Mil Med. 2012;177:693–701.

    Article  Google Scholar 

  18. Jackson GL, Melton LD, Abbott DH, et al. Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs. J Clin Oncol. 2010;28:3176–3181.

    Article  Google Scholar 

  19. Sohn MW, Arnold N, Maynard C, et al. Accuracy and completeness of mortality data in the Department of Veterans Affairs. Popul Health Metr. 2006;4:2.

    Article  Google Scholar 

  20. Duffy SW, Nagtegaal ID, Wallis M, et al. Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival. Am J Epidemiol. 2008;168:98–104.

    Article  Google Scholar 

Download references

Funding

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.

Author information

Authors and Affiliations

  1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Theresa Nguyen Wenker, Mimi C. Tan, Yan Liu & Hashem B. El-Serag

  2. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Mimi C. Tan & Hashem B. El-Serag

  3. Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Aaron P. Thrift

  4. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA

    Aaron P. Thrift

Authors
  1. Theresa Nguyen Wenker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mimi C. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hashem B. El-Serag
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aaron P. Thrift
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Aaron P. Thrift.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wenker, T.N., Tan, M.C., Liu, Y. et al. Prior Diagnosis of Barrett’s Esophagus Is Infrequent, but Associated with Improved Esophageal Adenocarcinoma Survival. Dig Dis Sci 63, 3112–3119 (2018). https://doi.org/10.1007/s10620-018-5241-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5241-y

Keywords

Search

Navigation