P-OGC15 Impact of postoperative systemic treatment on survival for oesophageal adenocarcinoma after preoperative chemotherapy and oesophagectomy

Abstract Background Perioperative chemotherapy is widely used in the treatment of oesophageal cancer with substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of cases, reflecting uncertainty about its benefit. This study estimates the effect of postoperative chemotherapy after surgery for oesophageal cancer using a large population-based dataset and modern statistical methods. Methods Patients with oesophageal adenocarcinoma diagnosed between 2012 and 2018 and underwent preoperative chemotherapy followed by surgery, were identified from a national level audit in England and Wales (National Oesophagogastric Cancer Audit). Postoperative therapy was defined as the receipt of at least one cycle of systemic chemotherapy within 90 days of surgery. The comparative effectiveness of postoperative chemotherapy compared to observation was estimated using inverse propensity treatment weighting (IPTW). Results The study included 2,814 patients, in whom postoperative therapy was given to 1,054 (37.5%). Patients who received postoperative therapy were younger, with a lower ASA grade and were less likely to have surgical complications of any type, including anastomotic leak (all p < 0.001). Tumour characteristics were similar in both groups. Weighted median survival times for patients having no treatment or postoperative chemotherapy were 45.4 months and 57.5 months respectively. There was a life expectancy difference at five years of 2.9 months in favour of postoperative chemotherapy (95%CI 1.1–4.8 months, p < 0.001) with a Hazard Ratio of 0.80 (95%CI 0.70-0.91, p < 0.001). Conclusions Among patients with oesophageal adenocarcinoma treated with preoperative chemotherapy and surgery, improved overall survival was observed in those patients who received postoperative chemotherapy. Minimising surgical complications and improving patient fitness could increase the use of postoperative chemotherapy, leading to better outcomes for patients with oesophageal adenocarcinoma.

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‘Missed’ oesophageal adenocarcinoma and high‐grade dysplasia in Barrett's oesophagus patients: A large population‐based study

United European Gastroenterology Journal ◽

10.1177/2050640617737466 ◽

2018 ◽

Vol 6 (4) ◽

pp. 519-528 ◽

Cited By ~ 7

Author(s):

Margreet Putten ◽

Brian T Johnston ◽

Liam J Murray ◽

Anna T Gavin ◽

Damian T McManus ◽

...

Keyword(s):

Large Population ◽

Population Based ◽

High Grade Dysplasia ◽

Barrett’S Oesophagus ◽

Oesophageal Adenocarcinoma ◽

High Grade ◽

Population Based Study ◽

Barrett's Oesophagus

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Effectiveness of Non-Pharmaceutical Interventions on Child and Staff COVID-19 Cases in US Summer Camps

10.1101/2021.02.18.21250271 ◽

2021 ◽

Author(s):

Helen H. Suh ◽

Julianne Meehan ◽

Laura Blaisdell ◽

Laurie Browne

Keyword(s):

Large Population ◽

Relative Effectiveness ◽

National Level ◽

Population Based ◽

Summer Camps ◽

Limited Information ◽

Effective Constant ◽

New Information ◽

The Us ◽

Pharmaceutical Interventions

AbstractBackgroundMost camps remained closed during Summer 2020, due to concerns regarding child transmission of SARS-CoV-2 and limited information about the effectiveness of non-pharmaceutical interventions (NPIs) within child congregate settings.MethodsWe surveyed US camps about on-site operations, camper and staff demographics, COVID-19 cases amongst campers and staff, and NPI usage as related to pre-camp quarantines, facial coverings, physical distancing, cleaning, and facility modifications. For all NPIs, save quarantines, responses were provided on a 5-point Likert scale format.ResultsWithin 486 on-site camps, a range of NPIs were instituted, most often related to reduced camper interactions, staff face coverings, cleaning, and hand hygiene. Camper facial coverings were less common, with campers always wearing masks at ∼34% of the camps. Approximately 15% of camps reported 1+ confirmed COVID-19 case in either campers or staff, with three camps reporting a COVID outbreak. In both single and multi-NPI analyses, the risk of COVID-19 cases was lowest when campers always wore facial coverings. While less effective, constant use of staff facial coverings and targeted physical distancing measures, but not pre-camp quarantine, also reduced COVID-19 risks.ConclusionsWe found constant facial coverings, especially for campers, and targeted physical distancing measures to reduce risks of SARS-CoV-2 transmission within summer camps. Our findings provide valuable guidance for future operations of camp and other child congregate settings with regard to efficient and effective NPI usage to mitigate SARS-CoV-2 infection.What’s Known on This SubjectApproximately 82% of US overnight camps did not open during Summer 2020 due to concerns regarding children’s ability to transmit SARS-CoV-2. Camps that did operate during this time instituted varied non-pharmaceutical interventions (NPIs) to reduce SARS-CoV-2 transmission, with little information available on the effectiveness of these NPIs within child congregate settings. Large population-based studies are needed to improve our understanding of the extent of SARS-CoV-2 infection amongst children and their caregivers and to determine whether and to what degree child congregate programs can safely open during the pandemic.What This Study AddsOur study, the largest survey of COVID-19 cases in child congregate settings at the national level, provides new information on the relative effectiveness of NPIs on mitigating COVID cases among children and staff within camp settings. We showed COVID-19 case rates in campers and staff to be low relative to corresponding case rates in the US and found constant camper facial coverings to be the most effective risk reduction method for SARS-CoV-2 transmission within camps. While less effective, constant use of staff facial coverings and targeted physical distancing measures, but not pre-camp quarantines, were also shown to reduce COVID-19 risks. Our findings has important implications for child congregate settings, helping to guide their successful opening and operation.

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A dietary pattern rich in lignans, quercetin and resveratrol decreases the risk of oesophageal cancer

British Journal Of Nutrition ◽

10.1017/s0007114514003055 ◽

2014 ◽

Vol 112 (12) ◽

pp. 2002-2009 ◽

Cited By ~ 28

Author(s):

Yulan Lin ◽

Agneta Yngve ◽

Jesper Lagergren ◽

Yunxia Lu

Keyword(s):

Oesophageal Cancer ◽

Dietary Pattern ◽

Animal Studies ◽

Population Based ◽

Protective Role ◽

Oesophageal Adenocarcinoma ◽

Reduced Rank Regression ◽

Swedish Population ◽

Cancer Data ◽

Potential Risk Factors

Dietary lignans, quercetin and resveratrol have oestrogenic properties, and animal studies suggest that they synergistically decrease cancer risk. A protective effect of lignans on the development of oesophageal cancer in humans has recently been demonstrated, and the present study aimed to test whether these three phytochemicals synergistically decrease the risk of oesophageal cancer. Data from a Swedish nationwide population-based case–control study that recruited 181 cases of oesophageal adenocarcinoma (OAC), 158 cases of oesophageal squamous-cell carcinoma (OSCC), 255 cases of gastro-oesophageal junctional adenocarcinoma (JAC) and 806 controls were analysed. Exposure data were collected through face-to-face interviews and questionnaires. The intake of lignans, quercetin and resveratrol was assessed using a sixty-three-item FFQ. Reduced-rank regression was used to assess a dietary pattern, and a simplified dietary pattern score was categorised into quintiles on the basis of the distribution among the control subjects. Unconditional multivariable logistic regression provided OR with 95 % CI, adjusted for all the potential risk factors. A dietary pattern rich in lignans, quercetin and resveratrol was mainly characterised by a high intake of tea, wine, lettuce, mixed vegetables, tomatoes, and whole-grain bread and a low intake of milk. There were dose-dependent associations between simplified dietary pattern scores and all types of oesophageal cancer (all P for trend < 0·05). On comparing the highest quintiles with the lowest, the adjusted OR were found to be 0·24 (95 % CI 0·12, 0·49) for OAC, 0·31 (95 % CI 0·15, 0·65) for OSCC, and 0·49 (95 % CI 0·28, 0·84) for JAC. The results of the present study indicate that a dietary pattern characterised by the intake of lignans, quercetin and resveratrol may play a protective role in the development of oesophageal cancer in the Swedish population.

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The proportion of oesophageal adenocarcinoma patients with prior barrett's oesophagus: results from a large population based cohort

Gut ◽

10.1136/gut.2011.239301.359 ◽

2011 ◽

Vol 60 (Suppl 1) ◽

pp. A169-A169

Author(s):

S. Bhat ◽

H. G. Coleman ◽

D. McManus ◽

A. T. Gavin ◽

L. J. Murray ◽

...

Keyword(s):

Large Population ◽

Population Based ◽

Barrett’S Oesophagus ◽

Oesophageal Adenocarcinoma ◽

Barrett's Oesophagus

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Chronic acid-suppressant use and risk of Oesophageal cancer: protocol for a longitudinal study using a large population based cohort

10.1101/2021.02.15.21251618 ◽

2021 ◽

Author(s):

Julia Hippisley-Cox ◽

Xue W Mei ◽

Pui San Tan ◽

Rebecca Fitzgerald ◽

Carol Coupland ◽

...

Keyword(s):

Cohort Study ◽

Oesophageal Cancer ◽

Public Involvement ◽

Large Population ◽

Acid Reflux ◽

Patient And Public Involvement ◽

Oesophageal Adenocarcinoma ◽

Cancer Type ◽

List Type ◽

Academic Journal

AbstractIntroductionOesophageal cancer is the sixth most common cause for cancer related deaths with over 450,000 new cases and 400,000 resulting deaths per year globally. Most cases in the UK are adenocarcinoma with some of the poorest outcomes from this cancer type in Europe -- mainly due to late diagnosis. The main risk factor for oesophageal adenocarcinoma is chronic reflux disease and due to the high prevalence and non-specific nature of these symptoms most patients are often managed with acid-reflux medications (e.g. Proton Pump Inhibitors (PPIs)) without referral for endoscopy. For those patients that are referred the endoscopy is normal in over 70% of cases, and there is not enough capacity within the NHS for endoscopy especially considering colon cancer screening.The primary aim of this project is to improve early identification of individuals at risk of oesophageal cancer and reduce over-use of prescription antacids.Methods and analysisWe will conduct a longitudinal cohort study consisted of adults 40 years and over who are free of oesophageal cancer at study entry, using the QResearch database for data gathered between 2000 and 2020. The main exposure is the use of prescription antacids which includes PPI, H2RA, and other aluminium and magnesium containing antacids. The exposure will be categorised based on active ingredients, dose, and duration of use and will be modelled as a time-varying covariate.Ethics and disseminationEthical approval for this project was obtained from the QResearch Scientific Committee [Ref: OX39, project title “DELTA - integrated Diagnostic solution for Early detection of Oesophageal cAncer”]. This project has been supported by patient and public involvement panels. We intend to submit the findings for peer-reviewed publication in an academic journal and disseminate them to the public.Strength and limitations of this studyThis is an open cohort study comprising a nationally representative sample of English population.The cohort consists of GP clinic data linked to hospital records, the English national cancer registry and English national death registry.This study has access to detailed information on acid-suppressant prescriptions, allowing analysis with consideration of the specific compound, dose, and duration of exposure.This study is limited by high rates of missing data for cancer grade and stage, although completeness has improved in recent years, this will be accounted for using appropriate multiple imputation techniques.

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