Barrett's esophagus surveillance in a prospective Dutch multi-center community-based cohort of 985 patients demonstrates low risk of neoplastic progression

Background and Aims

Barrett's esophagus (BE) is accompanied by an increased risk of developing esophageal cancer. Accurate risk‐stratification is warranted to improve endoscopic surveillance. Most data available on risk factors is derived from tertiary care centers or from cohorts with limited surveillance time or surveillance quality. The aim of this study was to assess endoscopic and clinical risk factors for progression to high‐grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in a large prospective cohort of BE patients from community hospitals supported by an overarching infrastructure to ensure optimal surveillance quality.

Methods

A well‐defined prospective multicenter cohort study was initiated in six community hospitals in the Amsterdam region in 2003. BE patients were identified by PALGA search and included in a prospective surveillance program with a single endoscopist performing all endoscopies at each hospital. Planning and data collection was performed by experienced research nurses who attended all endoscopies. Endpoint was progression to HGD/EAC.

Results

Nine hundred eighty‐five patients were included for analysis. During median follow‐up of 7.9 years (IQR 4.1–12.5) 67 patients were diagnosed with HGD (n = 28) or EAC (n = 39), progression rate 0.78% per patient‐year. As a clinical risk factor age at time of endoscopy was associated with neoplastic progression (HR 1.05; 95% CI 1.03–1.08). Maximum Barrett length and low‐grade dysplasia (LGD) at baseline were endoscopic predictors of progression (HR 1.15; 95% CI 1.09–1.21 and HR 2.36; 95% CI 1.29–4.33).

Conclusion

Risk of progression to HGD/EAC in a large, prospective, community‐based Barrett's cohort was low. Barrett's length, LGD and age were important risk factors for progression.

(www.trialregister.nl NTR1789)

Abstract P6-11-15: Comparison of QoL according to treatment received. First cohort study in Mexico

Background: In México, there are more than 57 million women with breast cancer, and more than 7 million of these patients live in Mexico State; 12.4% of breast cancer diagnosis are being made in here. The diagnosis and treatment of patients with breast cancer changes their quality of life (QOL) on a physical, psychological, social and sexual basis.

Objectives: The main purpose of this study is to examine the changes in the QOL of breast cancer patients treated at the State of Mexico Cancer Center (ISSEMyM), applying the EORT QLQ-C30 and QLQ-BR23. The secondary aim of the study is to describe the Health-Related Quality of Life (HRQoL), including partner relationships, sexual function, and body image concerns of breast cancer survivors. (BCS).

Design: A longitudinal, prospective, descriptive and analytical cohort study was made; with bivariate analysis and correlations search. We used Kolmogorov-Smirnov test for normal continuous variables. To evaluate changes in follow-up we use ANOVA test of repeated measures and post-hoc analysis. Significance was set at p <0.05

Method: QOL questionnaires were applied every 4 months followed for a year, the first one being done before the patient was informed of confirmed breast cancer diagnosis. A sample of 112 women with primary breast cancer were enrolled. The sample type is probability, non-confessional, consecutive cases.

Results: Primary cancer treatment has a negative impact on QOL comparing to data collected at the basal assessment (before confirmatory diagnosis of cancer). Average age 54 years (25-85). FIGO stage in situ in 5%, Ia, IIa and IIb 18%, IIIa 8%, IIIb 6%, IIIc 12% and IV 15%. LuminalA 40%, LuminalB 24%, Her2 15%, Triple negative 21%. The mean overall health score was 64.7±26.7 at baseline and 65.8±19.3, 65.3±19.6, 72.1±15.1 at 4.8 and 12 months, respectively. Physical, emotional, cognitive, sexual and social functioning, as well as symptoms and sexual pleasure present statistical significance (p.0000) regardless of age, stage or treatment received.

Conclusions: This is the first longitudinal, prospective, descriptive and analytical cohort made in Mexico that assesses changes in QOL of breast cancer patients. There is a significant decrease in post-surgery physical function in our patients. However, there is no significant difference between the results observed in patients undergoing conservative surgery versus those who received radical surgery, nor for patients receiving surgery plus radiation therapy versus surgery plus systemic therapy. Also in the body image category component in our study, an important decrease in the QOL of the patients undergoing surgery is demonstrated, this is more evident in early stages of disease. In patients who recieved chemotherapy, symptoms were a negative influence in QOL and just near a half came to a basal status a year after treatment started. Finally, patients with surgery as first treatment have a faster return to their basal QOL.

This work opens an invaluable opportunity to improve our medical behavior towards breast cancer patients, treated at the ISSEMyM State of Mexico Cancer Center. It obliges us to create a multidisciplinary team that permanently assesses patients, identifying the aspects of their daily work, which alter their QOL.

Citation Format: Medina JM, Gonzalez AB, Rivera F, Serrano R, Machado MM, García M. Comparison of QoL according to treatment received. First cohort study in Mexico [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-15.

Endoscopic risk factors for neoplastic progression in patients with Barrett's oesophagus

Barrett's oesophagus is a precursor lesion for oesophageal adenocarcinoma, which generally has a poor prognosis. Patients diagnosed with Barrett's oesophagus therefore undergo regular endoscopic surveillance to detect neoplastic lesions at a curable stage. The efficacy of endoscopic surveillance of Barrett's oesophagus patients is, however, hampered by difficulties to detect early neoplasia endoscopically, biopsy sampling error, inter-observer variability in histological assessment and the relatively low overall progression rate. Efficacy and cost-effectiveness of Barrett's surveillance may be improved by using endoscopic and clinical characteristics to risk-stratify Barrett's patients to high- and low-risk categories. Recent national and international surveillance guidelines have incorporated Barrett's length and presence of low-grade dysplasia in the advised surveillance intervals. In this review we will discuss endoscopic characteristics that may be associated with neoplastic progression in Barrett's oesophagus and that may be used to tailor surveillance in Barrett's patients.

Serodiagnosis of leprosy in patients' contacts by enzyme-linked immunosorbent assay

Serum samples from 3336 contacts of leprosy patients were tested for antiphenolic glycolipid I antibodies by enzyme-linked immunosorbent assay with the albumin coupled synthetic disaccharide antigen. The overall positivity rate was 9.3%. No significant differences were seen between a group of household contacts of lepromatous patients and those of the other types of the disease. The proportion of ELISA positives was slightly higher in the relatives as compared to workplace contacts and neighbours but significantly different only between the two former (p less than 0.05). Among those contacts with absorbance values higher than 0.100, 5 new leprosy patients were diagnosed, 2 of them with positive skin smears. A sixth contact was detected with a very high absorbance value in whom no single skin lesion was found but whose lepromin reaction was 0 mm and the skin smear showed a bacteriological index of 3+.

Subxiphoid M-mode echocardiography in atrioventricular defects

M-mode echocardiograms obtained using the subxiphoid position of the transducer were compared with those obtained using the parasternal position in 21 children with atrioventricular defects. In the 16 children with complete atrioventricular defect, it was always possible to demonstrate a common valve orifice wholly occupying the space between the anterior and posterior cardiac walls with no interventricular septal tissue in the plane of the orifice. Scanning between the plane of this orifice and the ventricular cavity demonstrated a ventricular septum in all cases, separating components of the atrioventricular valve apparatus from each other, corroborating the impression that the valve was straddling the ventricular septum and, therefore, that the valve was common to both ventricles. No septal tissue was detected in scans ranging between the aortic valve and the common orifice in these 16 children. In the five children with partial atrioventricular defects, two atrioventricular orifices separated by septum could be demonstrated. The subxiphoid approach in these 21 children defined the anatomy of atrioventricular defects more clearly and more readily than the parasternal approach.