Gastroenterology

Gastroenterology

Volume 122, Issue 3, March 2002, Pages 633-640
Gastroenterology

Clinical Research
Surveillance and survival in Barrett's adenocarcinomas: A population-based study,☆☆

https://doi.org/10.1053/gast.2002.31879Get rights and content

Abstract

Background & Aims: Guidelines recommend periodic endoscopic surveillance of Barrett's esophagus (BE) patients to detect and treat early esophageal adenocarcinomas; however, no trials or population-based studies exist. We evaluated the association between endoscopic surveillance of BE and survival among esophageal/gastric cardia adenocarcinoma patients. Methods: We studied a cohort of 23 BE patients, among 589 esophageal or gastric cardia adenocarcinoma patients diagnosed between 1990–1998 at Northern California Kaiser Permanente (a large health maintenance organization). We measured the presence of BE, detection of cancer by endoscopic surveillance, cancer stage, mortality, and potential confounders. Results: BE was diagnosed in 135 of 589 adenocarcinoma patients, with 23 BE patients diagnosed greater than 6 months before cancer was diagnosed. Among these 23 patients, 73% of the surveillance-detected cancer patients (n = 15) were alive at the end of follow-up, compared with none of the patients without surveillance-detected cancers (n = 8; P = 0.001). All surveillance-detected cancer patients had low-stage disease and none died directly from cancer. The surveillance/survival association was not substantially altered by stratification for age at BE diagnosis or other potential confounders. Conclusions: Surveillance-detected BE-associated adenocarcinomas were associated with low-stage disease and improved survival. Additional studies are needed to evaluate potential biases and whether screening/surveillance programs decrease mortality among all patients in surveillance. Few patients (3.9%) had a BE diagnosed before their cancer. Thus, even if current surveillance techniques are effective, they are unlikely to substantially impact the population's mortality from esophageal cancer; better methods are needed to identify at risk patients.

GASTROENTEROLOGY 2002;122:633-640

Section snippets

Data sources

The study population consisted of all esophageal and gastric cardia adenocarcinomas recorded in the Northern California Kaiser Permanente (NCKP) cancer registry between 1990 and 1998. NCKP is a large, group-model, health maintenance organization with approximately 2.7 million members. It membership is representative of the age, sex, and ethnic distributions of the San Francisco Bay Area.36 An unpublished 1999 survey sample of health plan members indicated that approximately 64% are non-Hispanic

Results

The NCKP cancer registry identified 628 adenocarcinoma patients. Eliminating duplicate reporting left 623 unique patients; medical records were available for 605 patients (96%). After record review, 16 patients without clearly documented cardia or esophageal cancers were excluded, leaving 589 total cancers for the final analysis (339 esophageal and 250 cardia cancers). A total of 64 patients (10.9%) had an EGD performed more than 6 months before their cancer diagnosis, of which 23 patients

Discussion

This study's results indicate that, among patients with esophageal and gastric cardia adenocarcinomas and a prior diagnosis of BE, surveillance-detected cancer patients have a lower stage of disease and improved survival at the end of follow-up compared with patients without surveillance-detected cancers. Despite the small patient population, there was no evidence that this surveillance-survival relationship was substantially confounded by age at BE diagnosis, year of BE or cancer diagnoses,

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    Address requests for reprints to: Douglas A. Corley, M.D., M.P.H., GI 2-West, 2238 Geary Boulevard, San Francisco, California 94115. e-mail: [email protected]; fax: (415) 833-3364.

    ☆☆

    Supported by the American Digestive Health Foundation/TAP Outcomes Research Award, and the National Institutes of Health Mentored Clinical Scientist Development Award.

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