Meta-Analysis
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World J Gastroenterol. Jul 28, 2014; 20(28): 9611-9617
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9611
Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus
Piers Gatenby, Christine Caygill, Christine Wall, Santanu Bhatacharjee, James Ramus, Anthony Watson, Marc Winslet
Piers Gatenby, Christine Caygill, Christine Wall, Santanu Bhatacharjee, James Ramus, Anthony Watson, Marc Winslet, Division of Surgery and Interventional Science, UCL, London, NW32QG, United Kingdom
Author contributions: All the authors contributed to substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.
Supported by Barrett’s Oesophagus Campaign; the Wexham Gastrointestinal Trust; the Childwick Trust; the RL St J Harmsworth Memorial Research Fund; the David and Frederick Barclay Foundation
Correspondence to: Piers Gatenby, MD, Division of Surgery and Interventional Science, UCL, Royal Free Campus, Pond Street, London, NW32QG, United Kingdom. p.gatenby@ucl.ac.uk
Telephone: +44-20-74726223 Fax: +44-20-74726224
Received: November 5, 2013
Revised: February 7, 2014
Accepted: March 12, 2014
Published online: July 28, 2014
Processing time: 264 Days and 10.6 Hours
Abstract

AIM: To investigate the lifetime risk of development of esophageal adenocarcinoma and/or high-grade dysplasia in patients diagnosed with Barrett’s esophagus.

METHODS: Data were extracted from the United Kingdom National Barrett’s Oesophagus Registry on date of diagnosis, patient age and gender of 7877 patients from who had been registered from 35 United Kingdom centers. Life expectancy was evaluated from United Kingdom National Statistics data based upon gender and age at year at diagnosis. These data were then used with published estimates of annual adenocarcinoma and high-grade dysplasia incidences from meta-analyses and large population-based studies to estimate overall lifetime risk of development of these study endpoints.

RESULTS: The mean age at diagnosis of Barrett’s esophagus was 61.6 years in males and 67.3 years in females. The mean life expectancy at diagnosis was 23.1 years in males, 20.7 years in females and 22.2 years overall. Using data from published meta-analyses, the lifetime risk of development of adenocarcinoma was between 1 in 8 and 1 in 14 and the lifetime risk of high-grade dysplasia or adenocarcinoma was 1 in 5 to 1 in 6. Using data from 3 large recent population-based cohort studies the lifetime risk of adenocarcinoma was between 1 in 10 and 1 in 37 and of the combined end-point of high-grade dysplasia and adenocarcinoma was between 1 in 8 and 1 in 20. Age at Barrett’s esophagus diagnosis is reducing and life expectancy is increasing, which will partially counter-balance lower annual cancer incidence.

CONCLUSION: There is a significant lifetime risk of development of high-grade dysplasia and adenocarcinoma in Barrett’s esophagus.

Keywords: Barrett esophagus; Esophageal neoplasms; Forecasting; Meta-analysis; Cohort studies

Core tip: The mean life expectancy for patients at diagnosis of Barrett’s esophagus is 22 years. Based on current estimates for high-grade dysplasia and adenocarcinoma incidence, the lifetime risk of requiring an intervention for high-grade dysplasia or adenocarcinoma development based on data from recent meta-analyses is 1 in 5 to 1 in 6 and based on data from recent population-based studies is between 1 in 8 and 1 in 20.