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Publication Detail
Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Sawas T, Killcoyne S, Iyer PG, Wang KK, Smyrk TC, Kisiel JB, Qin Y, Ahlquist DA, Rustgi AK, Costa RJ, Gerstung M, Fitzgerald RC, Katzka DA, Noorani A, Edwards PAW, Grehan N, Nutzinger B, Hughes C, Fidziukiewicz E, Bornschein J, MacRae S, Crawte J, Contino G, Li X, Rue RDL, O'Donovan M, Miremad A, Malhotra S, Tripathi M, Tavaré S, Lynch AG, Eldridge M, Secrier M, Bower L, Devonshire G, Perner J, Jammula S, Davies J, Crichton C, Carroll N, Safranek P, Hindmarsh A, Sujendran V, Hayes SJ, Ang Y, Preston SR, Oakes S, Bagwan I, Save V, Skipworth RJE, Hupp TR, O'Neill JR, Tucker O, Beggs A, Taniere P, Puig S, Underwood TJ, Noble F, Owsley J, Barr H, Shepherd N, Old O, Lagergren J, Gossage J, Davies A, Chang F, Zylstra J, Mahadeva U, Goh V, Ciccarelli FD, Sanders G, Berrisford R, Harden C, Bunting D, Lewis M, Cheong E, Kumar B, Parsons SL, Soomro I, Kaye P, Saunders J, Lovat L, Haidry R, Eneh V, Igali L, Scott M, Sothi S, Suortamo S, Lishman S, Hanna GB, Peters CJ, Grabowska A, Turkington R
  • Publication date:
    01/12/2018
  • Pagination:
    1720, 1728.e4
  • Journal:
    Gastroenterology
  • Volume:
    155
  • Issue:
    6
  • Status:
    Published
  • Print ISSN:
    0016-5085
Abstract
© 2018 AGA Institute 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.
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