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Endoscopy for gastroesophageal reflux disease and survival in esophageal adenocarcinoma.
- Source :
-
International journal of cancer [Int J Cancer] 2020 Jul 01; Vol. 147 (1), pp. 93-99. Date of Electronic Publication: 2019 Oct 18. - Publication Year :
- 2020
-
Abstract
- Gastroesophageal reflux disease (GERD) is a risk factor of esophageal adenocarcinoma (EAC) and the most common indication for upper gastrointestinal endoscopy. Yet, whether GERD or endoscopy practice influence survival in EAC is largely unknown and was assessed in our study.This nationwide cohort study included all Swedish residents diagnosed with EAC in 1997-2013 with follow-up to 2018. Exposures were history of GERD and endoscopies prior to EAC. The main outcome was EAC-specific 5-year mortality. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounders. Among 6,600 EAC patients (79.3% males, median age 70 years) followed for 9,138 person-years, 440 (6.7%) had GERD and 592 (9.0%) had ≥1 endoscopy before EAC diagnosis. GERD was associated with a decreased risk of mortality (adjusted HR 0.71, 95% CI 0.64-0.80), which was only slightly attenuated by adjustment for prior endoscopies (HR 0.79, 95% CI 0.70-0.90), and further adjustments also for tumor stage and surgical resection (HR 0.74, 95% CI 0.62-0.89). Compared to EAC patients without prior endoscopy, mortality was unchanged in GERD patients having undergone 1 or 2 endoscopies before EAC diagnosis (HR 1.02, 95% CI 0.80-1.31, for 1 endoscopy; HR 0.90, 95% CI 0.63-1.30, for 2 endoscopies), while the mortality was decreased in patients with ≥3 endoscopies (HR 0.55, 95% CI 0.36-0.85). Our study indicates that GERD may be associated with a better prognosis in the event of EAC; however, the use of endoscopy screening has a limited impact on survival unless performed very frequently.<br /> (© 2019 UICC.)
- Subjects :
- Adenocarcinoma diagnosis
Aged
Cohort Studies
Endoscopy, Gastrointestinal statistics & numerical data
Esophageal Neoplasms diagnosis
Female
Gastroesophageal Reflux diagnosis
Humans
Male
Middle Aged
Sweden epidemiology
Adenocarcinoma mortality
Esophageal Neoplasms mortality
Gastroesophageal Reflux mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1097-0215
- Volume :
- 147
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- International journal of cancer
- Publication Type :
- Academic Journal
- Accession number :
- 31583704
- Full Text :
- https://doi.org/10.1002/ijc.32721