Surveillance of Barrett's esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study

• Published in: The American journal of gastroenterology Vol. 109; no. 8; pp. 1215 - 1222
• Main 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
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.08.2014
• Subjects: Adenocarcinoma - mortality; Aged; Aged, 80 and over; Barrett Esophagus - epidemiology; Barrett Esophagus - pathology; Esophageal Neoplasms - mortality; Female; Gastroenterology; Humans; Incidence; Male; Middle Aged; Netherlands - epidemiology; Population Surveillance; Precancerous Conditions - epidemiology; Precancerous Conditions - pathology; Predictive Value of Tests; Registries; Risk Factors; Survival Rate; Netherlands
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2014.156

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. 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. 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). 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.