TY - JOUR
T1 - Incidence and prediction of unrelated mortality after successful endoscopic eradication therapy for Barrett's neoplasia
AU - van Munster, Sanne N
AU - Verheij, Eva P D
AU - Ozdemir, Özge
AU - Toes-Zoutendijk, Esther
AU - Lansdorp-Vogelaar, Iris
AU - Nieuwenhuis, Esther A
AU - Cotton, Cary C
AU - Weusten, Bas L A M
AU - Alvarez Herrero, Lorenza
AU - Alkhalaf, Alaa
AU - Schenk, B Ed
AU - Schoon, Erik J
AU - Curvers, Wouter L
AU - Koch, Arjun D
AU - de Jonge, Pieter-Jan F
AU - Tang, Thjon J
AU - Nagengast, Wouter B
AU - Westerhof, Jessie
AU - Houben, Martin H M G
AU - Shaheen, Nicholas J
AU - Bergman, Jacques J G H M
AU - Pouw, Roos E
N1 - Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2024/6
Y1 - 2024/6
N2 - BACKGROUND AND AIMS: Follow-up (FU) strategies after endoscopic eradication therapy (EET) for Barrett's neoplasia do not consider the risk of mortality from other causes than esophageal adenocarcinoma (EAC). We aimed to evaluate this risk during long-term FU, and to assess whether the Charlson Comorbidity Index (CCI) can predict mortality.METHODS: We included all patients with successful EET from the nationwide Barrett-registry in the Netherlands. Data were merged with National Statistics for accurate mortality data. We evaluated annual mortality rates (AMR, per 1000 person-years) and standardized mortality ratio (SMR) for other-cause mortality. Performance of CCI was evaluated by discrimination and calibration.RESULTS: We included 1,154 patients with a mean age of 64 years (±9). During median 59 months (p25-p75 37-91; total 6,375 person-years), 154 patients (13%) died from other causes than EAC (AMR 24.1 [95%CI 20.5-28.2]), most commonly non-EAC-cancers (n=58), cardiovascular (n=31), or pulmonary diseases (n=26). Four patients died from recurrent EAC (AMR 0.5 [95%CI 0.1-1.4]). Compared to the general Dutch population, mortality was significantly increased for patients in the lowest three age quartiles (i.e. age <71 years). Validation of CCI in our population showed good discrimination (C-statistic 0.78 [95%CI 0.72-0.84]) and fair calibration.CONCLUSION: The other-cause mortality risk after successful EET was more than 40 times higher [48; 95% CI 15-99] than the risk of EAC-related mortality. Our findings reveal that younger post-EET patients exhibit a significantly reduced life expectancy when compared to the general population. Furthermore, they emphasize the strong predictive ability of CCI for long-term mortality after EET. This straightforward scoring system can inform decisions regarding personalized FU, including appropriate cessation timing. (NL7039).
AB - BACKGROUND AND AIMS: Follow-up (FU) strategies after endoscopic eradication therapy (EET) for Barrett's neoplasia do not consider the risk of mortality from other causes than esophageal adenocarcinoma (EAC). We aimed to evaluate this risk during long-term FU, and to assess whether the Charlson Comorbidity Index (CCI) can predict mortality.METHODS: We included all patients with successful EET from the nationwide Barrett-registry in the Netherlands. Data were merged with National Statistics for accurate mortality data. We evaluated annual mortality rates (AMR, per 1000 person-years) and standardized mortality ratio (SMR) for other-cause mortality. Performance of CCI was evaluated by discrimination and calibration.RESULTS: We included 1,154 patients with a mean age of 64 years (±9). During median 59 months (p25-p75 37-91; total 6,375 person-years), 154 patients (13%) died from other causes than EAC (AMR 24.1 [95%CI 20.5-28.2]), most commonly non-EAC-cancers (n=58), cardiovascular (n=31), or pulmonary diseases (n=26). Four patients died from recurrent EAC (AMR 0.5 [95%CI 0.1-1.4]). Compared to the general Dutch population, mortality was significantly increased for patients in the lowest three age quartiles (i.e. age <71 years). Validation of CCI in our population showed good discrimination (C-statistic 0.78 [95%CI 0.72-0.84]) and fair calibration.CONCLUSION: The other-cause mortality risk after successful EET was more than 40 times higher [48; 95% CI 15-99] than the risk of EAC-related mortality. Our findings reveal that younger post-EET patients exhibit a significantly reduced life expectancy when compared to the general population. Furthermore, they emphasize the strong predictive ability of CCI for long-term mortality after EET. This straightforward scoring system can inform decisions regarding personalized FU, including appropriate cessation timing. (NL7039).
U2 - 10.1053/j.gastro.2024.02.033
DO - 10.1053/j.gastro.2024.02.033
M3 - Article
C2 - 38447738
SN - 0016-5085
VL - 166
SP - 1058
EP - 1068
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -