title: Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression.
abstract: OBJECTIVE
  Endoscopic surveillance for Barrett's oesophagus (BO) is under discussion given the overall low incidence of neoplastic progression and lack of evidence that it prevents advanced oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the impact of endoscopic BO surveillance on tumour stage and survival of patients with neoplastic progression.
  
  
  METHODS
  783 patients with BO of at least 2 cm were included in a multicentre prospective cohort and followed during surveillance according to the American College of Gastroenterology guidelines. Cases of high-grade dysplasia and OAC were identified during follow-up. OAC staging was performed according to the 7th UICC-AJCC classification. Survival data were collected and crosschecked using death and municipal registries. Data from patients with OAC in the general population were obtained from the Dutch cancer registry. We compared survival of patients with BO with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population.
  
  
  RESULTS
  53 patients with BO developed high-grade dysplasia or OAC during surveillance. Thirty-five (66%) were classified as stage 0, 14 (26%) as stage 1 and 4 (8%) as stage 2. OAC was diagnosed at an earlier stage during BO surveillance than in the general population (p<0.001). Survival of patients with BO with neoplastic progression was not significantly worse than those of patients without neoplastic progression and similar to survival of patients with stage 0 or stage 1 OAC in the general population.
  
  
  CONCLUSIONS
  OAC is detected at an earlier stage during BO surveillance than in the general population with good survival rates.
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Kastelein
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: S H
authors.initials: SH
authors.lastname: van Olphen
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M C W
authors.initials: MC
authors.lastname: Spaander
authors.affiliation: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bruno
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D018450:Disease Progression; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies; D016019:Survival Analysis
keywords: BARRETT'S CARCINOMA; BARRETT'S METAPLASIA; BARRETT'S OESOPHAGUS; OESOPHAGEAL CANCER; SURVEILLANCE