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- Title
Surveillance of Barrett's Esophagus and Mortality from Esophageal Adenocarcinoma: A Population-Based Cohort Study.
- Authors
Verbeek, Romy E; Leenders, Max; ten Kate, Fiebo J W; van Hillegersberg, Richard; Vleggaar, Frank P; van Baal, Jantine W P M; van Oijen, Martijn G H; Siersema, Peter D
- Abstract
OBJECTIVES:Barrett's esophagus (BE) is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Patients with a known diagnosis of BE are usually advised to participate in an endoscopic surveillance program, but its clinical value is unproven. Our objective was to compare patients participating in a surveillance program for BE before EAC diagnosis with those not participating in such a program, and to determine predictive factors for mortality from EAC.METHODS:All patients diagnosed with EAC between 1999 and 2009 were identified in the nationwide Netherlands Cancer Registry. These data were linked to Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief, the Dutch Pathology Registry. Prior surveillance was evaluated, and multivariable Cox proportional hazards regression analysis was performed to identify predictors for all-cause mortality at 2-year and 5-year follow-up.RESULTS:In total, 9,780 EAC patients were included. Of these, 791 (8%) patients were known with a prior diagnosis of BE, of which 452 (57%) patients participated in an adequate endoscopic surveillance program, 120 (15%) patients in an inadequate program, and 219 (28%) patients had a prior BE diagnosis without participating. Two-year (and five-year) mortality rates were lower in patients undergoing adequate surveillance (adjusted hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.64-0.92) when compared with patients with a prior BE diagnosis who were not participating. Other factors associated with lower mortality from EAC were lower tumor stage (stage I vs. IV, HR=0.19, 95% CI=0.16-0.23) and combining surgery with neoadjuvant chemo/radiotherapy (HR=0.66, 95% CI=0.58-0.76).CONCLUSIONS:Participation in a surveillance program for BE, but only if adequately performed, reduces mortality from EAC. Nevertheless, it remains to be determined whether such a program is cost-effective, as more than 90% of all EAC patients were not known to have BE before diagnosis.
- Subjects
TREATMENT of esophageal cancer; BARRETT'S esophagus; ESOPHAGEAL cancer patients; MORTALITY; CANCER chemotherapy; CANCER radiotherapy; ENDOSCOPY; DIAGNOSIS
- Publication
American Journal of Gastroenterology (Springer Nature), 2014, Vol 109, Issue 8, p1215
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1038/ajg.2014.156