Case Western Reserve University School of Medicine omaha, NE
Omar A. Alaber, MD1, Apoorva K. Chandar, MBBS, MPH2, Don C. Codipilly, MD3, Prashanthi N. Thota, MD4, Prasad G. Iyer, MD, MS3, Amitabh Chak, MD2; 1Case Western Reserve University School of Medicine, Cleveland, OH; 2University Hospitals of Cleveland, Cleveland, OH; 3Mayo Clinic, Rochester, MN; 4Cleveland Clinic Foundation, Cleveland, OH
Introduction: Adenocarcinomas of the esophagogastric junction (EGJ) are thought to represent a distinct tumor entity with a rapidly increasing incidence in the Western hemisphere. Whether they arise in the distal esophagus or from the gastric cardia is an unresolved debate. Our objective was to compare demographics and risk factors between EGJ neoplasms and esophageal adenocarcinoma (EAC). Methods: We obtained aggregate data from a national de-identified patient database (IBM Explorys Solutions, IBM, Inc.) that contains electronic health records from 27 major integrated U.S. healthcare systems from 1999 to present. First, we identified all adult patients (≥18 years) with EGJ cancer and non-junctional distal EAC diagnosis using Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and compared the prevalence of risk factors between the two groups. Later, we identified all patients with diagnosis of gastroesophageal reflux disease (GERD) and assessed the incremental risk of each of these cancer types with additional risk factors. The risk factors we evaluated were male gender, Caucasian race, age > 50 years, smoking history, and obesity (BMI > 30). Odds ratios (OR) and 95% confidence intervals (CI) for the ORs were calculated for the risk of association of GERD and multiple combined risk factors with the development of EGJ cancer or distal EAC. Results: There were 9840 EGJ cancers and 9870 distal EAC in the database. The demographic characteristics and risk factors for EGJ cancer and EAC were similar (Table 1). A total of 6,283,670 patients had GERD in the database. In GERD patients, the risk of getting a new diagnosis EGJ cancer and EAC were 0.02% and 0.01% respectively. When compared to GERD patients with no risk factor, 1 or more additional risk factors showed an incremental increase in the odds of development of EGJ cancers (Table 2) and EAC (Table ). The risk of a new diagnosis of EGJ cancer was highest with the greatest number of risk factors, but slightly attenuated when compared to that of EAC. Discussion: Our study shows that EGJ cancer and distal EAC have similar demographic and risk factor profiles. The incremental and stronger association of GERD and multiple additional risk factors with EGJ cancers suggests a potential of targeted screening of individuals with these risk factors similar to that of Barrett’s esophagus and EAC.
Table 1: Demographic Characteristics of EGJ cancers and distal EAC
Table 2: Association of risk factors with EGJ adenocarcinoma
Table 3: Association of risk factors with non-junctional EAC
Disclosures: Omar Alaber indicated no relevant financial relationships. Apoorva Chandar indicated no relevant financial relationships. Don Codipilly indicated no relevant financial relationships. Prashanthi Thota indicated no relevant financial relationships. Prasad Iyer indicated no relevant financial relationships. Amitabh Chak indicated no relevant financial relationships.