Cpj Caygill

PTU-145 The Rotherham Barrett’s Oesophagus Surveillance Programme. The Final Outcome after 37 Years

Introduction We present the long-term outcome of Barrett’s oesophagus (BO) observed over 37 years at a District General Hospital. We comment on the risk of developing oesophageal adenocarcinoma (OAC), its outcome, and on the value of endoscopic surveillance. Methods The study includes all patients diagnosed with BO from 1.1.1977 to 31.12.2011 and followed-up until 31.12.2013 (37 years). Patients with prevalent OAC were excluded from analysis. Data were prospectively collected and updated at every visit and all deaths recorded. Patients were followed-up by surveillance endoscopy or if contraindicated by age or co-morbidity then by clinic visit or telephone survey, with urgent endoscopy reserved for recurrence of symptoms for all patients. To compare outcome we divided OAC patients according to their method of follow-up at the time OAC was diagnosed. To adjust for the confounding factor of age when creating survival estimates we applied a Cox proportional hazards regression which included gender, age, and age squared (for there is evidence that the relationship with age and survival is not linear). Results Total numbers: 1977–2011 n = 1381. BO numbers steadily increased but plateaued towards the end of the study. BO diagnosis was confirmed by histology in 88%. Outcome: In a total FU of 10366 patient-years (mean 7.5y range 0–36y), 54/1381 (3.9%) developed OAC (mean interval 9 years, SD 5.5, range 13 months–25.4 years). Thus 1 OAC developed per 192 patient-years of FU i.e. 0.52% per year. Mortality: Deaths from all causes were 417/1381 (30.2%). Surveillance and survival: Mortality was significantly lower in the 37 patients under endoscopic surveillance at the time OAC was diagnosed (51% vs 88% p = 0.0141) due in part to the older age and co-morbidity of the other 17 in whom serial endoscopy was contraindicated (mean age 67y vs 75y p = 0.002, respectively). However, after adjusting for age there was no significant difference in mortality between the two groups (p = 0.08). Importantly though, the estimated hazard rate ratio was lower in the surveillance group (0.64, 95% CI 0.30 to 1.48). Conclusion Reduction of risk: The risk of dying from OAC was reduced by about one-third in those under endoscopic surveillance at the time OAC was diagnosed. Identifying such a reduction of risk is a very useful indicator of the value of surveillance. Numbers and implications: This substantial long-term study was still not large enough to show a significant reduction in death once adjusted for confounding factors. Our results stress the need for individual centres to contribute to data warehouses such as national registries. We now have clear evidence that BO surveillance confers benefit. With today’s technology which offers a wider scope of both palliative and curative treatments, and a continued systematic and disciplined approach, we have reason to expect that endoscopic surveillance will give even better results in the future. Disclosure of Interest None Declared

PTU-158 The Influence of Social Class on Progression of Barrett’s Oesophagus to Oesophageal Adenocarcinoma

Introduction The incidence of oesophageal adenocarcinoma (OAC) has been rapidly increasing over the last three to four decades in many western nations, including the UK. Barrett’s oesophagus (BO) is the only known precursor condition for OAC. Surveillance of BO may be undertaken with the goal of detecting dysplasia and early neoplasia prior to the development of incurable cancer. The identification of subpopulations of subjects at highest risk of cancer development should allow more effective targeted surveillance. Methods Clinical records of 2896 patients from two centres in the UK, who have consented and registered with the UK Barrett’s Oesophagus Registry (UKBOR), were used for the purpose of this study. Data on patient’s occupation were obtained from hospital records, or from death certificates where available. The most widely used measure of social class in the UK is the ‘Registrar General’s Classification’ which assigns a social class category (I-V with subdivision of class III into III N [non-manual workers] and III M [manual workers] against individual occupation. Social class I are the professionals and higher managers, II and III are junior managers/supervisors, III and IV comprises of semiskilled and manual occupations and those in V are unskilled workers. A Chi-squared goodness of fit test was used to test for significance of the association of social class in both BO and OAC. Results In the BO group, 1824 people had usable information on occupation. Table 1 shows the observed (O) cases of BO and OAC in each of the social classes and the number of expected (E) cases of OAC assuming an equal proportion of social class developed OAC (p-value – 0.003) The O/E results demonstrate an excess of patients progressing to OAC in social class III M, and a lower than expected number of cases in social classes I, III N and V.Abstract PTU-158 Table 1 The influence of social class on the progression of BO to OAC Social Class BO OAC (observed – O) OAC (Expected – E) O/E I 142 2 9.6 0.20 II 320 24 23.1 1.03 IIIN 288 11 20.1 0.55 IIIM 600 51 43.7 1.16 IV 289 18 20.6 0.87 V 185 4 12.7 0.31 Conclusion Our study shows that more OAC is observed in BO patients in social class III M than expected whereas fewer are observed in social class I, IIIN and V than expected. References 1 Jansson C, Johansson AL, Nyren O, et al. Socioeconomicfactors and risk of esophageal adenocarcinoma: a nationwide Swedish case-control study. Cancer Epidemiol Biomarkers Prev 2005;14: 1754–1761. 2 Islami F, Kamnagar F, Nasrollahzadeh D, et al. Socio-economic status and oesophageal cancer: results from a population based case-control study in a high risk area. Int J Epidemiol 2009;38:978–988. Disclosure of Interest None Declared