Risk of oesophageal adenocarcinoma in individuals with Barrett's oesophagus |
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| Affiliation: | 1. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, NS 67, 171 76 Stockholm, Sweden;2. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;3. Division of Cancer Studies, King''s College London, Guy''s Campus, London SE1 1UL, UK;1. Clinical Operational Research Unit, University College London, UK;2. Surgical & Interventional Trials Unit, Division of Surgery & Interventional Science, University College London, UK;1. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas;2. Division of Hematology and Oncology, Department of Medicine, Cancer Center, and Genomic Sciences & Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Germany;4. Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia;5. Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland & Aberdeen Center for Health Data Science, University of Aberdeen, Scotland;6. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;7. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;8. Department of Population Sciences, Beckman Research Institute and City of Hope Comprehensive Cancer Center, Duarte, California;9. Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany;10. Department of Epidemiology, MD Anderson Cancer Center, Houston, Texas;11. Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina;12. Pharmacogenomic Epidemiology, Ontario Cancer Institute, Toronto, Ontario, Canada;13. Cancer Research UK, Cambridge Institute, Cambridge, UK;14. Department of Oncology, University of Cambridge, Cambridge, UK;15. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK;16. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut;17. Department of Medicine II, Sana Klinikum, Offenbach, Germany;18. Department of Internal Medicine II, Evangelisches Krankenhaus, Düsseldorf, Germany;19. Department of Gastroenterology and Interdisciplinary Endoscopy, Vivantes Wenckebach-Klinikum, Berlin, Germany;20. Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany;21. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany;22. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany;23. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany;24. Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Germany;25. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany;26. Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany;27. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota;28. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington;29. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;30. School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK;31. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina;32. Division of Research, Kaiser Permanente Northern California, Oakland, California;33. San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, California;34. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany;35. Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK;36. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland;37. Cancer Control, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia;38. Center for Human Genetics, University Hospital of Marburg, Marburg, Germany;39. Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas;1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota;2. Division of Gastroenterology, University of California-San Diego, La Jolla, California;3. Division of Biomedical Informatics, University of California-San Diego, La Jolla, California;1. Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas;3. Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri;4. Division of Gastroenterology, Swedish Medical Group, Seattle, Washington;6. Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California;5. Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, the Netherlands;7. Division of Gastroenterology, Hepatology, and Nutrition, University of South Alabama, Mobile, Alabama;12. Department of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona;8. Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois;10. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;9. Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland |
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| Abstract: | IntroductionRecent studies have indicated a lower incidence rate of oesophageal adenocarcinoma (OAC) in individuals with Barrett's oesophagus (BO) than most earlier studies. Our objective was to assess the risk of OAC in a Swedish unselected cohort of individuals with BO.MethodsThis population-based cohort study included all Swedish residents diagnosed with BO in 2006–2013, identified through the Swedish Patient Registry. The cohort members were followed from the date of first BO diagnosis until the first occurrence of OAC, high-grade dysplasia (HGD), death, emigration or end of study period. The main outcome was incidence rates with 95% confidence intervals (CIs) of OAC.ResultsAmong 7932 participants with BO and 18,415 person-years of follow-up, the overall incidence of OAC was 1.47 (95% CI 0.91–2.02) per 1000 person-years. When stratified into follow-up periods after BO diagnosis, the incidence rate of OAC was 15.53 (4.77–26.29) from 7 to 30 d, 4.10 (0.82–7.38) from 31 to 100 d, 1.87 (0.00–3.99) from 101 d to 6 months, 1.44 (0.18–2.70) from >6 months to 1 year, 0.94 (0.36–1.53) from >1 year to 3 years and 2.17 (1.14–3.21) from >3 years to the end of follow-up. The median follow-up time was 2.13 person-years.ConclusionThis population-based study indicates that OAC is primarily diagnosed during the first months following an initial diagnosis of BO. This could justify a changed surveillance strategy of BO with a repeated thorough endoscopy shortly after initial BO diagnosis to identify prevalent early OAC or HGD. |
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| Keywords: | Oesophageal adenocarcinoma Oesophageal neoplasm Surveillance Barrett's oesophagus High-grade dysplasia |
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