Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study.
OBJECTIVE
Endoscopic surveillance of Barrett's oesophagus (BO) provides an opportunity to detect early stage oesophageal adenocarcinoma (OAC). We sought to determine the proportion of OAC patients with a prior diagnosis of BO on a population basis and to evaluate the influence of a prior diagnosis of BO on survival, taking into account lead and length time biases.


METHODS
A retrospective population-based study of all OAC patients in Northern Ireland between 2003 and 2008. A prior BO diagnosis was determined by linkage to the Northern Ireland BO register. Stage distribution at diagnosis and histological grade were compared between patients with and without a prior BO diagnosis. Overall survival, using Cox models, was compared between patients with and without a prior BO diagnosis. The effect of adjusting the survival differences for histological grade and estimates of lead and length time bias was assessed.


RESULTS
There were 716 OAC cases, 52 (7.3%) of whom had a prior BO diagnosis. Patients with a prior BO diagnosis had significantly lower tumour stage (44.2% vs. 11.1% had stage 1 or 2 disease; p<0.001), a higher rate of surgical resection (50.0% vs. 25.5%; p<0.001) and had a higher proportion of low/intermediate grade tumours (46.2% vs. 26.5%; p=0.011). A prior BO diagnosis was associated with significantly better survival (HR for death 0.39; 95% CI 0.27 to 0.58), which was minimally influenced by adjustment for age, sex and tumour grade (adjusted HR 0.44; 95% CI 0.30 to 0.64). Correction for lead time bias attenuated but did not abolish the survival benefit (HR 0.65; 95% CI 0.45 to 0.95) and further adjustment for length time bias had little effect.


CONCLUSIONS
The proportion of OAC patients with a prior diagnosis of BO is low; however, prior identification of BO is associated with an improvement in survival in OAC patients.
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Shivaram K
SK
Bhat
Department of Pathology, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland.
Damian T
DT
McManus
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Helen G
HG
Coleman
Department of Gastroenterology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland.
Brian T
BT
Johnston
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Christopher R
CR
Cardwell
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Una
U
McMenamin
Northern Ireland Cancer Registry, Queens University Belfast, Belfast, Northern Ireland.
Finian
F
Bannon
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Blanaid
B
Hicks
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Grace
G
Kennedy
Northern Ireland Cancer Registry, Queens University Belfast, Belfast, Northern Ireland.
Anna T
AT
Gavin
Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland.
Liam J
LJ
Murray
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications* / Q000175:diagnosis; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis
BARRETT'S OESOPHAGUS; CANCER EPIDEMIOLOGY; OESOPHAGEAL CANCER