Adenocarcinoma of the esophagus with and without Barrett mucosa

Hypothesis: Previous studies have demonstrated an improved prognosis in pat ients with Barrett adenocarcinoma as compared with esophageal adenocarcinom a without Barrett. It has been suggested that an earlier presentation due t o gastroesophageal reflux disease (GERD) may lead to detection adenocarcino ma at an earlier stage. Design: The records of 178 patients with esophageal adenocarcinoma presenti ng to Roswell Park Cancer Institute (Buffalo, NY) between 1991 and 1996 wer e reviewed. Main Outcome Measures: The clinical presentation, work-up, therapy, and out come were compared between patients with Barrett esophagus (n=66) and those without endoscopic or pathologic evidence of Barrett esophagus (n=112). Results: There were several favorable prognostic signs in the Barrett group , including smaller turners, lower grade, and earlier stage. More patients in the Barrett group had surgically resectable tumors, resulting in an impr oved overall survival. However, there were no differences in the type or du ration of symptoms. Overall, very few patients presented because of GERD, a nd only slightly more in the Barrett group (14% vs 4%). While survival grea tly improved in patients diagnosed with Barrett due to GERD, this did not a ccount for the difference in prognosis. Conclusions: Improved prognosis and survival for the Barrett group is not d ue to earlier presentation due to symptoms of GERD. It is more likely that all esophageal adenocarcinoma arises from Barrett esophagus, and that it is obscured by larger tumors. Reviews limited to resected patients greatly ov erestimate the number of adenocarcinoma cases diagnosed due to GERD. Increa sed efforts to identify high-risk patients and initiate screening are neces sary to diagnose adenocarcinoma at an earlier stage.