Differential Response to Preoperative Chemoradiation and Surgery in Esophageal Adenocarcinomas Based on Presence of Barrettʹs Esophagus and Symptomatic Gastroesophageal Reflux

Background Barrettʹs esophagus and gastroesophageal reflux disease (GERD) are recognized to predispose to esophageal adenocarcinoma. Abdel-Latif and colleagues recently suggested that esophageal adenocarcinoma patients with GERD might be resistant to multimodality treatment. In this study, we investigated potential differences in clinical outcomes in esophageal adenocarcinoma patients based on the presence of identifiable Barrettʹs mucosa and/or history of symptomatic GERD. Methods Eighty-four patients with resectable esophageal adenocarcinoma, who completed the planned preoperative chemoradiation and underwent a potentially curative esophageal resection were retrospectively evaluated. Postoperative survival was compared between patients with or without underlying Barrettʹs esophagus and history of symptomatic GERD. Patients with pathologic complete response (path CR) and those with partial or no response (path PR) were compared to determine if presence of Barrettʹs esophagus and history of symptomatic GERD influence the path CR rates. Results We found significantly lower postoperative survival in patients with Barrettʹs associated adenocarcinoma (vs adenocarcinoma arising de novo, p = 0.031) and patients with symptomatic GERD (vs patients without symptomatic GERD, p = 0.019). Furthermore, the subset of patients with path PR (vs path CR) after chemoradiation have a significantly higher proportion of patients with Barrettʹs esophagus (HR = 4.38, confidence interval [CI] = 1.39 to 13.83, p = 0.012) and patients with GERD (HR = 2.71, CI = 1.13 to 6.50, p = 0.026). Conclusions Patients with esophageal adenocarcinoma may have differences in response to preoperative chemoradiation based on the presence of Barrettʹs esophagus and history of symptomatic GERD.