title: Adenocarcinoma of the lower esophagus with Barrett's esophagus or without Barrett's esophagus: differences in patients' survival after preoperative chemoradiation.
abstract: It remains unclear whether the overall survival (OS) of patients with localized esophageal adenocarcinoma (LEA) with Barrett's esophagus (BE) (Barrett's-positive) and those with LEA without BE (Barrett's-negative) following preoperative chemoradiation is different. Based on the published differences in the molecular biology of the two entities, we hypothesized that the two groups will have a different clinical biology (and OS). In this retrospective analysis, all patients with LEA had surgery following preoperative chemoradiation. Apart from age, gender, baseline clinical stage, location, class of cytotoxics, post-therapy stage, and OS, LEAs were divided up into Barrett's-positive and Barrett's-negative groups based on histologic documentation of BE. The Kaplan-Meier and Cox regression analytic methods were used. We analyzed 362 patients with LEA (137 Barrett's-positive and 225 Barrett's-negative). A higher proportion of Barrett's-positive patients had (EUS)T2 cancers (27%) than those with Barrett's-negative cancer (17%). More Barrett's-negative LEAs involved gastroesophageal junction than Barrett's-positive ones (P = 0.001). The OS was significantly shorter for Barrett's-positive patients than that for Barrett's-negative patients (32 months vs. 51 months; P = 0.04). In a multivariate analysis for OS, Barrett's-positive LEA (P = 0.006), old age (P = 0.016), baseline positive nodes (P = 0.005), more than 2 positive (yp)N (P = 0.0001), higher (yp)T (P = 0.003), and the use of a taxane (0.04) were the independent prognosticators. Our data demonstrate that the clinical biology (reflected in OS) is less favorable for patients with Barrett's-positive LEA than for patients with Barrett's-negative LEA. Our intriguing findings need confirmation followed by in-depth molecular study to explain these differences.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: P
authors.initials: P
authors.lastname: Cen
authors.forename: A M
authors.initials: AM
authors.lastname: Correa
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Le
authors.forename: D
authors.initials: D
authors.lastname: Maru
authors.forename: S
authors.initials: S
authors.lastname: Anandasabapathy
authors.forename: Z
authors.initials: Z
authors.lastname: Liao
authors.forename: W L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: S G
authors.initials: SG
authors.lastname: Swisher
authors.forename: R
authors.initials: R
authors.lastname: Komaki
authors.forename: W A
authors.initials: WA
authors.lastname: Ross
authors.forename: A
authors.initials: A
authors.lastname: Vaporciyan
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D001471:Barrett Esophagus / Q000453:epidemiology*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies