BACKGROUND & AIMS: Most patients with esophageal adenocarcinoma (EAC) present de novo. 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.
METHODS: 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. Two cohorts from the Mayo Clinic and a UK multicenter prospective cohort were included.
RESULTS: The Mayo Clinic cohort had 411 patients with EAC, and 49.3% with BE-IM showed a survival benefit compared with those without (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.34-0.57, P < .001). In a multivariable analysis, BE-IM was associated with better survival independent of age, sex, stage, and tumor location and length (adjusted HR 0.66, 95% CI 0.5-0.88, P = .005). The UK cohort included1417 patients, and 45% with BE-IM showed a survival benefit compared with those without (hazard ratio 0.59, 95% CI 0.5-0.69, P < .001), with continued significance in multivariable analysis that included age, sex, stage, and tumor location (adjusted HR 0.77, 95% CI 0.64-0.93, P = .006).
CONCLUSION: Two types of EAC can be characterized based on the presence or absence of Barrett epithelium. These findings have implications for understanding the etiology of EAC, determining prognosis, and developing optimal clinical strategies to identify patients at risk.