Li, A.G.K.; Fernandex, E.; Baird, J.; Park, K.G.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA48
Academic Journal
Background: Epidemiological studies suggest that Barrett's specialised intestinal metaplasia (SIM) is a pre-malignant precursor for adeno-carcinomas of the oesophagus (OAC) and oesophago-gastric junction (OGJ). Surveillance programmes are currently based on the stringent endoscopic biopsy of all patients with SIM to identify "at risk" individuals. Aim: To determine whether Barrett's SIM is an independent prognostic factor in patients with carcinoma of the oesophagus and stomach. Methods: The Scottish audit of Gastric and Oesophageal Cancer (SAGOC) analysed survival amongst patients with respect to possible contributory factors including Barrett's oesophagus. Univariate and multivariate analyses was performed to account for compounding factors and hazard ratios (HR) for 1 year survival were derived from this. Results: A history of pre-existing Barrett's oesophagus was present in 14% of OACs, 4.3% OGJ tumours, 0.9% squamous cell carcinoma, and 0.9% of gastric tumours. In patients undergoing resectional surgery, Barrett's SIM was found in 44% of OACs, compared with 17% of OGJ tumours. Pathological data for the presence of SIM were not recorded in up to 44% and 55% respectively. Adjusted hazard ratios were as follows: 1 year survival for all patients with and without pre-existing Barrett's was 31% and 51.5%, respectively, and for those undergoing potential curative resection, was 52.7% and 72.6%, respectively. Conclusion: Survival odds are greater in patients with Barrett's than those without. This is increased in patients undergoing surgery with intent to cure and is independent of tumour stage and grade. However, given the prevalence oF known pre-existing Barrett's in this cohort, large scale surveillance programmes would benefit only a small number of individuals with tumours of the oesophagus and oesophago-gastric junction.


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