Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, United Kingdom; European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, United Kingdom.
Gastroenterology. 2018 Dec;155(6):1720-1728.e4. doi: 10.1053/j.gastro.2018.08.036. Epub 2018 Aug 27.
BACKGROUND & AIMS: Most patients with esophageal adenocarcinoma (EAC) present with de novo tumors. Although this could 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 Barrett esophagus (BE) with intestinal metaplasia (IM) at the time of EAC diagnosis.
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. We analyzed data from a cohort of patients with EAC from the Mayo Clinic (n=411; 203 with BE and IM) and a multicenter cohort from the United Kingdom (n=1417; 638 with BE and IM).
In the Mayo cohort, BE with IM had a reduced risk of death compared to patients without BE and IM (hazard ratio [HR] 0.44; 95% CI, 0.34-0.57; P<.001). In a multivariable analysis, BE with IM was associated with longer survival independent of patient age or sex, tumor stage or location, and BE length (adjusted HR, 0.66; 95% CI, 0.5-0.88; P=.005). In the United Kingdom cohort, patients BE and IM had a reduced risk of death compared with those without (HR, 0.59; 95% CI, 0.5-0.69; P<.001), with continued significance in multivariable analysis that included patient age and sex and tumor stage and tumor location (adjusted HR, 0.77; 95% CI, 0.64-0.93; P=.006).
Two types of EAC can be characterized based on the presence or absence of BE. These findings could increase our understanding the etiology of EAC, and be used in management and prognosis of patients.
大多数食管腺癌（EAC）患者表现为新发肿瘤。尽管这可能是由于筛查策略不足所致，但确切原因尚不清楚。我们比较了同时存在 EAC 时伴或不伴同步 Barrett 食管（BE）和肠上皮化生（IM）的患者的生存情况。
使用 Cox 比例风险回归分析临床数据，以评估同步 BE-IM 对 EAC 生存的影响，该影响独立于年龄、性别、TNM 分期和肿瘤位置。我们分析了来自梅奥诊所的 EAC 患者队列（n=411；203 例伴 BE 和 IM）和来自英国的多中心队列（n=1417；638 例伴 BE 和 IM）的数据。
在 Mayo 队列中，与无 BE 和 IM 的患者相比，同时存在 BE 和 IM 的患者死亡风险降低（风险比 [HR] 0.44；95%CI，0.34-0.57；P<.001）。在多变量分析中，独立于患者年龄或性别、肿瘤分期或部位以及 BE 长度，同时存在 BE 和 IM 与更长的生存相关（调整后的 HR，0.66；95%CI，0.5-0.88；P=.005）。在英国队列中，与无 BE 和 IM 的患者相比，同时存在 BE 和 IM 的患者死亡风险降低（HR，0.59；95%CI，0.5-0.69；P<.001），在包括患者年龄和性别以及肿瘤分期和肿瘤位置的多变量分析中仍然具有显著意义（调整后的 HR，0.77；95%CI，0.64-0.93；P=.006）。
可以根据是否存在 BE 来描述两种类型的 EAC。这些发现可以增加我们对 EAC 病因的理解，并用于患者的管理和预后。
