Patients with esophageal adenocarcinoma who displayed Barrett’s esophagus or intestinal metaplasia had better survival than patients without, according to research published in Gastroenterology.
Sawas, MD, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote that BE serves as a precursor lesion in many cases of esophageal adenocarcinoma (EAC), but in patients without BE or intestinal metaplasia (IM), it has been assumed that the cancer overgrows or replaces the lesion. However, the researchers hypothesized that there could be evidence of two completely different forms of EAC.
“There might be a group of patients with EAC without co-existing Barrett’s esophagus/IM (non-BE/IM) at the time of cancer diagnosis who have a more aggressive form of EAC which might lead to a poorer prognosis when compared to those with prevalent Barrett’s esophagus/IM (BE/IM),” they wrote.
Sawas and colleagues analyzed data from two cohorts of patients with EAC, one from the Mayo Clinic (n = 411) and a multicenter cohort from the United Kingdom (n = 1,417).
In the Mayo Clinic cohort, 49.3% of patients had BE and/or IM, and median overall survival for the entire cohort was 4 years. Patients with BE and/or IM had a higher median survival compared with those without (5.8 vs 2.3 years; P < .001). These patients also displayed a survival benefit compared with patients without BE or IM (HR = 0.44; 95% CI, 0.34-0.57). Investigators also found a survival benefit independent of age, sex, stage, and tumor location and length (adjusted HR = 0.66; 95% CI, 0.5-0.88).
In the U.K. cohort, 45% of patients had BE and/or IM, and median overall survival in the entire cohort was 1.6 years. Patients with BE and/or IM had a higher median survival compared with patients without (3.4 vs. 2 years; P < .001). Patients with BE and/or IM also displayed a survival benefit compared with patients without (HR = 0.59; 95% CI, 0.5-0.69). The benefit continued after adjusting for the same factors (aHR = 0.77; 95% CI, 0.64-0.93).
“This study suggests that there are phenotypically two types of [EAC] – one with grossly visible and/or histologically identifiable intestinal metaplasia in the esophagus and one without,” they wrote. “Furthermore, the presence or absence of these findings may influence the ability for early detection in this disease through screening for BE.” – by Alex Young
Disclosures: Sawas reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.