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Identification of prognostic phenotypes of esophageal adenocarcinoma in two independent cohorts.

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cam.issuedOnline2018-08-27
dc.contributor.authorSawas, Tarek
dc.contributor.authorKillcoyne, Sarah
dc.contributor.authorIyer, Prasad G
dc.contributor.authorWang, Kenneth K
dc.contributor.authorSmyrk, Thomas C
dc.contributor.authorKisiel, John B
dc.contributor.authorQin, Yi
dc.contributor.authorAhlquist, David A
dc.contributor.authorRustgi, Anil K
dc.contributor.authorOCCAMS Consortium
dc.contributor.authorCosta, Rui J
dc.contributor.authorGerstung, Moritz
dc.contributor.authorFitzgerald, Rebecca C
dc.contributor.authorKatzka, David A
dc.contributor.orcidFitzgerald, Rebecca [0000-0002-3434-3568]
dc.date.accessioned2018-11-24T00:31:07Z
dc.date.available2018-11-24T00:31:07Z
dc.date.issued2018-12
dc.description.abstractBACKGROUND & AIMS: Most patients with esophageal adenocarcinoma (EAC) present de novo. Although this may 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 BE/intestinal metaplasia of the esophagus (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. Two cohorts from the Mayo Clinic and a U.K. multicenter prospective cohort were included. RESULTS: The Mayo cohort had 411 EAC patients with 49.3% with BE/IM demonstrating a survival benefit as compared to those without (hazard ratio (HR), 0.44; 95% CI: 0.34 - 0.57, P<0.001). In a multivariable analysis BE/IM was associated with better survival independent of age, sex, stage and tumor location and length (adjusted HR: 0.66, 95% CI: 0.5-0.88, P=0.005). The UK cohort contained 1417 patients, 45% with BE/IM demonstrating a survival benefit as compared with non-BE/IM patients (HR 0.59, 95% CI: 0.5-0.69, P<0.001) with continued significance in multivariable analysis that included age, sex, stage, and tumor location (adjusted HR 0.77, 95% CI: 0.64-0.93, P=0.006). CONCLUSION: Two types of esophageal adenocarcinoma can be characterized based on the presence or absence of Barrett's epithelium. These findings have implications for understanding the etiology of EAC and determining prognosis as well as for development of optimal clinical strategies to identify patients at risk.
dc.identifier.doi10.17863/CAM.33262
dc.identifier.eissn1528-0012
dc.identifier.issn0016-5085
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/285935
dc.languageeng
dc.language.isoeng
dc.publisherElsevier
dc.publisher.urlhttp://dx.doi.org/10.1053/j.gastro.2018.08.036
dc.subjectBarrett’s esophagus
dc.subjectEsophageal adenocarcinoma
dc.subjectEsophagus
dc.subjectSurvival
dc.titleIdentification of prognostic phenotypes of esophageal adenocarcinoma in two independent cohorts.
dc.typeArticle
dcterms.dateAccepted2018-08-20
prism.publicationNameGastroenterology
pubs.funder-project-idCancer Research Uk (None)
pubs.funder-project-idMRC (unknown)
pubs.funder-project-idMedical Research Council (MC_UU_12022/2)
rioxxterms.licenseref.startdate2018-08-20
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1053/j.gastro.2018.08.036

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