Endoscopic surveillance of patients with Barrett’s esophagus is recommended to detect esophageal adenocarcinoma, and its dysplasia precursors, but survival benefits are unclear.
Using Surveillance, Epidemiology, and End Results (SEER) and linked Medicare data, Dr Chin Hur and colleagues from Massachusetts, USA determined the impact of a prior Barrett’s esophagus diagnosis on survival in patients with esophageal adenocarcinoma.
The researchers analyzed focused on patients over age 65 with primary esophageal adenocarcinoma diagnosed in a SEER region from 2000–2011, and enrolled in Medicare.
The researchers identified patients with preexisting Barrett’s esophagus prior to esophageal adenocarcinoma diagnosis and compared this group to esophageal adenocarcinoma patients without a prior Barrett’s esophagus diagnosis.
|12% had preexisting Barrett’s esophagus|
|American Journal of Gastroenterology|
Among 4,978 SEER-Medicare patients identified with esophageal adenocarcinoma, 12% had preexisting Barrett’s esophagus.
Barrett’s esophagus patients had overall lower stage than those without preexisting Barrett’s esophagus.
The team observed that overall survival was better among patients in the Barrett’s esophagus group.
The researchers observed that this benefit persisted in the adjusted model.
After adjusting for lead-time bias, the hazard ratios attenuated to the null, with an unadjusted hazard ratios of 0.96, and adjusted hazard ratio of 0.99.
Dr Hur's team concludes, "Survival outcomes in patients with a Barrett’s esophagus diagnosis prior to esophageal adenocarcinoma were statistically better in both the unadjusted and adjusted Cox proportional hazards model."
"However, this benefit appears to be predominantly lead-time and length-time bias."