TY - JOUR
T1 - Surveillance of Barrett's Esophagus and Mortality from Esophageal Adenocarcinoma
T2 - A Population-Based Cohort Study
AU - Verbeek, Romy E.
AU - Leenders, Max
AU - ten Kate, Fiebo J. W.
AU - van Hillegersberg, Richard
AU - Vleggaar, Frank P.
AU - van Baal, Jantine W. P. M.
AU - van Oijen, Martijn G. H.
AU - Siersema, Peter D.
PY - 2014/8
Y1 - 2014/8
N2 - 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.
AB - 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.
KW - UNITED-STATES
KW - SURVIVAL
KW - CANCER
KW - CARCINOMA
KW - NETHERLANDS
KW - TRENDS
KW - STAGE
KW - CHEMORADIOTHERAPY
KW - METAANALYSIS
KW - ENDOSCOPY
U2 - 10.1038/ajg.2014.156
DO - 10.1038/ajg.2014.156
M3 - Article
C2 - 24980881
SN - 0002-9270
VL - 109
SP - 1215
EP - 1222
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 8
ER -