Comparison of the clinical and histological characteristics and survival of distal esophageal-gastroesophageal junction adenocarcinoma in patients with and without barrett mucosa.
BACKGROUND
The incidence of adenocarcinoma in the distal esophagus and at the gastroesophageal junction (GEJ) has been increasing in the last decades. It has been suggested that patients in whom Barrett mucosa can be identified in the surgical specimen have a better prognosis compared with those without. This has led to the belief that patients with and without Barrett mucosa may represent 2 distinct cancer types.


OBJECTIVE
Distal esophageal-GEJ adenocarcinoma with and without Barrett mucosa share the same origin, but differ only in clinical presentation and outcome.


METHODS
Retrospective cohort study in a university tertiary referral center.


METHODS
Between 1992 and 2002, 215 patients (173 men and 42 women; median age, 66 years; age range, 26-91 years) had esophagogastrectomy for adenocarcinoma of the distal esophagus-GEJ. Patients receiving neoadjuvant chemotherapy or radiation therapy were excluded.


METHODS
Clinical presentation, tumor characteristics, and survival were compared in patients with Barrett mucosa (n = 140) and those without (n = 75).


RESULTS
Patients with Barrett mucosa in the specimen had tumors that were diagnosed earlier; were smaller in size; earlier in stage, with fewer node metastases; and had a better 5-year survival.


CONCLUSIONS
Observed differences in survival between patients with distal esophageal-GEJ adenocarcinoma with and without Barrett mucosa can be explained by earlier diagnosis. Patients without Barrett mucosa have their tumors detected later, when the disease is more advanced. This suggests the possibility that tumors without Barrett mucosa are not of a different origin, but rather are larger tumors that may have overgrown areas of Barrett mucosa.
Portale
Giuseppe
G
Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA 90033, USA.
Peters
Jeffrey H
JH
Hagen
Jeffrey A
JA
Demeester
Steven R
SR
Gandamihardja
Tasha A K
TA
Tharavej
Chadin
C
Hsieh
Chih-Cheng
CC
Demeester
Tom R
TR
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate