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Ann Thorac Surg 1998;65:176-181
© 1998 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Prognosis of Adenocarcinoma Arising in Barrett’s Esophagus

Steven J. Hoff, MD, John L. Sawyers, MD, Charles D. Blanke, MD, Hak Choy, MD, James R. Stewart, MD

Section of Surgical Sciences, Department of Cardiac and Thoracic Surgery, Division of Medical Oncology, Division of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Dr Hoff, Cardiovascular Surgical Associates, 4230 Harding Rd, Suite 501 W, Nashville, TN 37205.

Presented at the Forty-third Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 7–9, 1996.

Background. The rising incidence of adenocarcinoma of the esophagus, as well as its association with Barrett’s esophagus, has been reported previously. We report our experience in treating patients with adenocarcinoma arising in Barrett’s esophagus.

Methods. A retrospective review was performed of 70 consecutive patients with adenocarcinoma of the esophagus treated between November 1988 and April 1996 with preoperative chemoradiation and resection. Demographics, pathologic features, and survival were compared with patients who developed adenocarcinoma of the esophagus without Barrett’s. Statistical analyses was performed using Student’s t test, Fisher’s exact test, and Kaplan-Meier where appropriate.

Results. Thirty-two (46%) patients had adenocarcinoma arising in Barrett’s esophagus. During the last 4 years, 72% (23 of 32) of patients with adenocarcinoma had coexistent Barrett’s. No differences in patients with or without Barrett’s with regard to age, sex, race, tumor location, preoperative chemotherapy, type of operation, or operative stage were observed. Tumors in patients with Barrett’s were larger (p = 0.017), had better differentiation (p = 0.002), and were less likely to have a complete response to preoperative chemoradiation (p = 0.05). Actuarial survival, however, was better in the group with associated Barrett’s esophagus (p = 0.033).

Conclusions. The incidence of adenocarcinoma of the esophagus arising in Barrett’s esophagus appears to be increasing. It may be distinct clinically and biologically from adenocarcinoma of the esophagus that does not develop in association with Barrett’s epithelium. Long-term survival was better in our patients with adenocarcinoma associated with Barrett’s esophagus.






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