Objective: Prior studies have suggested that adenocarcinoma associated with Barrett’s epithelium may represent a unique tumor biology. This has arisen from observations that patients with adenocarcinoma and residual Barrett’s in the surgical specimen may have better survival than those without residual Barrett’s. The aim of our study was to determine the influence of Barrett’s epithelium on survival of patients with esophageal adenocarcinoma as well as to identify factors predicting survival.
Methods: The study population consisted of 194 patients who underwent esophagectomy for adenocarcinoma. Eighty-four (43.3%) patients had Barrett’s epithelium identified in the surgical specimen. Mean age, M:F ratio, location of tumor, type of operation and mean follow-up were not significantly different between those with or without Barrett’s. Outcome measures included overall survival, morbidity and mortality and factors associated with prolonged survival. The effect of age, gender, operative approach, Barrett’s, stage, T and N-classification, and endoscopic surveillance on survival was assessed via logistic regression.
Results: Patients with adenocarcinoma associated with Barrett’s had significantly better 5-year survival as compared to those without Barrett’s, (37.2% v. 23.1%; p=0.020). Patients with Barrett’s also had earlier stage cancers (I-IIb) (57/82, 69.5% v. 35/110, 31.8%; p<0.05) and a higher prevalence of endoscopic surveillance (20/64, 31.3% v. 1/79, 1.3%; p<0.05) than those without Barrett’s. There was no difference in perioperative morbidity or mortality between the two groups. On multivariate analysis, tumor depth, nodal status and enrollment in a surveillance program were significant predictors of long-term survival. The presence of Barrett’s epithelium was not. Survival was also similar when those with and without Barrett’s epithelium were examined via matched pair analysis.
Conclusions: Long-term survival of patients with adenocarcinoma and Barrett’s epithelium in the surgical specimen is superior to those without evident Barrett’s epithelium. This survival advantage is due to earlier detection and to surveillance endoscopy and not the underlying tumor biology. Screening endoscopy and subsequent surveillance of patients with Barrett’s esophagus should be strongly encouraged to allow for the detection of esophageal adenocarcinoma at an earlier stage.