期刊
CANCER MEDICINE
卷 11, 期 4, 页码 1160-1171出版社
WILEY
DOI: 10.1002/cam4.4484
关键词
Barrett oesophagus; lead-time bias; oesophageal cancer; relative survival; surveillance
类别
资金
- Cancer Research UK [C8162/A16892, C8162/A25356]
- MRC [RG84369]
- Cancer Research UK Population Research Catalyst award [C8640/A23385]
The study found that patients with a prior diagnosis of Barrett esophagus had a survival advantage in esophageal cancer and adenocarcinoma cohorts, even if they had fewer endoscopies. This survival benefit was not fully explained by surveillance endoscopies.
Background Current guidelines recommend endoscopic surveillance for Barrett oesophagus (BE), but the value of surveillance is still debated. Using a combination of primary care, secondary care and cancer registry datasets, we examined the impact of a prior BE diagnosis, clinical and risk factors on survival from oesophageal cancer and adenocarcinoma. Methods Retrospective cohort study of patients aged 50 and above diagnosed with malignant oesophageal cancer between 1993 and 2014 using Clinical Practice Research Datalink (CPRD). All prior BE diagnoses and endoscopies were identified from CPRD and Hospital Episode Statistics. Histology information was obtained from linked cancer registry data. We used flexible parametric models to estimate excess hazard ratios (EHRs) for relative survival. We simulated the potential impact of lead-time by adding random lead-times from a variety of distributions to all those with prior BE. Results Among our oesophageal cancer (n = 7503) and adenocarcinoma (n = 1476) cohorts only small percentages, 3.4% and 5.3%, respectively, had a prior BE diagnosis. Two-year relative survival was better among patients with BE: 48.0% (95% CI 41.9-54.9) compared to 25.2% (24.3-26.2) without. Patients with BE had a better prognosis (EHR = 0.53, 0.41-0.68). Survival was higher even if patients with BE had fewer than two endoscopies (50.0%; 43.6-57.3). A survival benefit was still observed after lead-time adjustment, with a 20% absolute difference in 2-year survival using a 5 year mean sojourn time. Conclusions Patients with a prior BE diagnosis had a survival advantage. This was not fully explained by surveillance endoscopies.
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