Award: Fellows-in-Training Award (Esophagus Category)
Yuri Hanada, MD1, Sanne Hoefnagel, BS1, Bryan Linn1, Tiffany L. Mangels-Dick1, Prithwish Ghosh, MBBS1, Prasad G. Iyer, MD, MS1, Navtej Buttar, MD1, Louis Wong Kee Song, MD1, Kenneth K. Wang, MD, FACG2; 1Mayo Clinic, Rochester, MN; 2Mayo Clinic College of Medicine, Rochester, MN
Introduction: Barrett’s esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma (EAC). Endoscopic surveillance aims to detect histologic changes that can be treated with ablative and/or resection modalities before progression. However, data on long-term outcomes including overall and cancer-free survival and predictors to guide our therapeutic practices remain limited. Methods: This is a retrospective cohort study of adults who received care at Mayo Clinic’s BE Unit (Rochester, MN) between 1992 and 2019. Treatment modalities included: photodynamic therapy; radiofrequency ablation; thermal coagulation; spray cryoablation; endoscopic mucosal resection; endoscopic submucosal dissection. Survival regression analyses were performed. Results: Of 1033 patients (82.4% male, median age 66.0±15.0 y) with a median follow-up of 7 ± 7.9 y, 344 (33.3%) have died. Of 344 patients who died, 174 (16.8%) had EAC at baseline or developed EAC at any point during their follow-up; 97 patients had death specific data available, of which 38 (3.7%) died specifically of EAC or EAC-related complications. Median time to death from EAC was 48 months.
Poor overall survival was best predicted by older age (HR 1.1, 95% CI 1.1-1.1, p< 0.001), higher Charlson Comorbidity Index (HR 1.4, 95% CI 1.3-1.5, p< 0.001), and presenting histology of high grade dysplasia (HGD) or EAC compared to non-dysplastic BE (HGD HR 2.3, 95% CI 1.6-3.2, p< 0.001; EAC HR 6.1, 95% CI 4.4-8.6, p< 0.001) in both univariate and multivariate analyses. Time-dependent variables associated with improved survival included follow-up treatment with radiofrequency ablation (HR 0.6, 95% CI 0.4-0.9, p< 0.01), bipolar and/or multipolar coagulation (HR 0.6, 95% CI 0.4-0.8, p< 0.01), and photodynamic therapy (HR 0.8, 95% CI 0.6-1.0, p< 0.05). In contrast, cryoablation, which was predominantly used for salvage and/or palliative therapy, during follow-up was associated with poor survival (HR 2.1, 95% CI 1.1-4.0, p< 0.05). Poor disease-specific survival was best predicted by older age (HR 1.1, 95% CI 1.0-1.1, p< 0.001), higher Charlson Comorbidity Index (HR 1.3, 95% CI 1.1-1.5, p 0.001), and presenting histology of EAC (HR 60.9, 95% CI 8.2-452.5, p< 0.001). Discussion: In this large cohort reflecting almost 3 decades of surveillance expertise, BE surveillance is shown to be effective, particularly with respect to disease-specific survival among patients who appropriately enter into and follow a surveillance program before appearance of EAC.
Disclosures: Yuri Hanada indicated no relevant financial relationships. Sanne Hoefnagel indicated no relevant financial relationships. Bryan Linn indicated no relevant financial relationships. Tiffany Mangels-Dick indicated no relevant financial relationships. Prithwish Ghosh indicated no relevant financial relationships. Prasad Iyer: C2 Therapeutics – Grant/Research Support. Exact Sciences – Grant/Research Support. Medtronic – Grant/Research Support. Navtej Buttar indicated no relevant financial relationships. Louis Wong Kee Song indicated no relevant financial relationships. Kenneth Wang: CSA Medical – Other Financial or Material Support, Honoraria. Erbe – Grant/Research Support. Fujinon – Grant/Research Support. Medtronic – Other Financial or Material Support, Honoraria. Pentax Medical – Grant/Research Support.