Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4472
Peer-review started: July 30, 2018
First decision: August 27, 2018
Revised: September 3, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
To study factors associated with esophageal and non-esophageal cancer morbidity among Barrett’s esophagus (BE) patients.
A cohort study within a single tertiary center included 386 consecutive patients with biopsy proven BE, who were recruited between 2004-2014. Endoscopic and histologic data were prospectively recorded. Cancer morbidity was obtained from the national cancer registry. Main outcomes were BE related (defined as esophagus and cardia) and non-BE related cancers (all other cancers). Cancer incidence and all-cause mortality were compared between patients with high-grade dysplasia (HGD) and with low-grade or no dysplasia (non-HGD) using Kaplan-Meier curves and cox regression models.
Of the 386 patients, 12 had HGD, 7 had a BE related cancer. There were 75 (19.4%) patients with 86 cases of lifetime cancers, 76 of these cases were non-BE cancers. Seven (1.8%) and 18 (4.7%) patients had BE and non-BE incident cancers, respectively. Twelve (3.1%) patients had HGD as worst histologic result. Two (16.7%) and 16 (4.4%) incident non-BE cancers occurred in the HGD and non-HGD group, respectively. Ten-year any cancer and non-BE cancer free survival was 63% and 82% in the HGD group compared to 93% and 95% at the non-HGD group, respectively. Log-rank test for patients with more than one endoscopy, assuring longer follow up, showed a significant difference (P < 0.001 and P = 0.017 respectively). All-cause mortality was not significantly associated with BE HGD.
Patients with BE and HGD, may have a higher risk for all-cause cancer morbidity. The implications on cancer prevention recommendations should be further studied.
Core tip: Barrett’s esophagus (BE) is known to be associated with esophageal carcinoma (EAC) and increased all cause and cancer specific mortality, but EAC is responsible only for a minority of BE mortality cases. We found patients with high-grade dysplasia to be more prone to non-BE related cancers, on top of BE related cancers. Such information can affect the recommended extraesophageal surveillance, and contribute the debate about the cost-effectiveness of endoscopic surveillance and to health systems decision making.