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Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus

BACKGROUND: The absolute risk of oesophageal adenocarcinoma (EA) among individuals with Barrett's oesophagus (BE) is low and a majority of EA cases are diagnosed among individuals with no prior BE diagnosis. To ensure that insights from EA case–control studies are transferable to clinical manag...

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Autores principales: Cook, Michael B, Drahos, Jennifer, Wood, Shannon, Enewold, Lindsey, Parsons, Ruth, Freedman, Neal D, Taylor, Philip R, Ricker, Winnie, Abnet, Christian C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129823/
https://www.ncbi.nlm.nih.gov/pubmed/27780192
http://dx.doi.org/10.1038/bjc.2016.344
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author Cook, Michael B
Drahos, Jennifer
Wood, Shannon
Enewold, Lindsey
Parsons, Ruth
Freedman, Neal D
Taylor, Philip R
Ricker, Winnie
Abnet, Christian C
author_facet Cook, Michael B
Drahos, Jennifer
Wood, Shannon
Enewold, Lindsey
Parsons, Ruth
Freedman, Neal D
Taylor, Philip R
Ricker, Winnie
Abnet, Christian C
author_sort Cook, Michael B
collection PubMed
description BACKGROUND: The absolute risk of oesophageal adenocarcinoma (EA) among individuals with Barrett's oesophagus (BE) is low and a majority of EA cases are diagnosed among individuals with no prior BE diagnosis. To ensure that insights from EA case–control studies are transferable to clinical management of BE populations, we conducted a case–case study to compare the clinical presentation, medical history and survival of EA cases with and without a prior BE diagnosis in the Surveillance, Epidemiology and End Results Medicare database. METHODS: Eligible EA cases were diagnosed at age ⩾68 years during 1994–2009. There were 5271 EA cases in this study, 87% of which did not have a prior diagnosis of BE (EA-no prior BE). RESULTS: Multivariable case–case comparisons evidenced adverse associations of GERD, ever cigarette smoking, hypertension, dyslipidemia, weight loss, peptic ulcer and irritable bowel disease each in EA-prior BE compared with EA-no prior BE. Obesity, metabolic syndrome, impaired fasting glucose and diabetes did not differ between groups. EA-prior BE cases were diagnosed with less advanced disease, were more likely to undergo surgery and less likely to receive chemotherapy and radiotherapy, and had better overall mean survival (2.5 vs 1.4 years). This survival advantage persisted in the multivariable Cox model (HR=0.69, 95%CI: 0.60, 0.78), despite adjustment for many factors including stage, grade and clinical interventions. CONCLUSIONS: This study provides evidence that EA cases occurring among individuals previously diagnosed with BE are different from the large majority of EA cases that occur without a prior BE diagnosis. Regardless of whether these differences emanate from aetiology, biology and/or selection biases, they underscore the importance of a prudent approach in using knowledge from EAC case–control studies in the management of BE populations.
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spelling pubmed-51298232017-11-22 Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus Cook, Michael B Drahos, Jennifer Wood, Shannon Enewold, Lindsey Parsons, Ruth Freedman, Neal D Taylor, Philip R Ricker, Winnie Abnet, Christian C Br J Cancer Epidemiology BACKGROUND: The absolute risk of oesophageal adenocarcinoma (EA) among individuals with Barrett's oesophagus (BE) is low and a majority of EA cases are diagnosed among individuals with no prior BE diagnosis. To ensure that insights from EA case–control studies are transferable to clinical management of BE populations, we conducted a case–case study to compare the clinical presentation, medical history and survival of EA cases with and without a prior BE diagnosis in the Surveillance, Epidemiology and End Results Medicare database. METHODS: Eligible EA cases were diagnosed at age ⩾68 years during 1994–2009. There were 5271 EA cases in this study, 87% of which did not have a prior diagnosis of BE (EA-no prior BE). RESULTS: Multivariable case–case comparisons evidenced adverse associations of GERD, ever cigarette smoking, hypertension, dyslipidemia, weight loss, peptic ulcer and irritable bowel disease each in EA-prior BE compared with EA-no prior BE. Obesity, metabolic syndrome, impaired fasting glucose and diabetes did not differ between groups. EA-prior BE cases were diagnosed with less advanced disease, were more likely to undergo surgery and less likely to receive chemotherapy and radiotherapy, and had better overall mean survival (2.5 vs 1.4 years). This survival advantage persisted in the multivariable Cox model (HR=0.69, 95%CI: 0.60, 0.78), despite adjustment for many factors including stage, grade and clinical interventions. CONCLUSIONS: This study provides evidence that EA cases occurring among individuals previously diagnosed with BE are different from the large majority of EA cases that occur without a prior BE diagnosis. Regardless of whether these differences emanate from aetiology, biology and/or selection biases, they underscore the importance of a prudent approach in using knowledge from EAC case–control studies in the management of BE populations. Nature Publishing Group 2016-11-22 2016-10-25 /pmc/articles/PMC5129823/ /pubmed/27780192 http://dx.doi.org/10.1038/bjc.2016.344 Text en Copyright © 2016 Cancer Research UK http://creativecommons.org/licenses/by-nc-sa/4.0/ From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
spellingShingle Epidemiology
Cook, Michael B
Drahos, Jennifer
Wood, Shannon
Enewold, Lindsey
Parsons, Ruth
Freedman, Neal D
Taylor, Philip R
Ricker, Winnie
Abnet, Christian C
Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title_full Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title_fullStr Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title_full_unstemmed Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title_short Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett's oesophagus
title_sort pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of barrett's oesophagus
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129823/
https://www.ncbi.nlm.nih.gov/pubmed/27780192
http://dx.doi.org/10.1038/bjc.2016.344
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