Role of Aspirin, Proton Pump Inhibitors and Prior Endoscopy on Staging at Diagnosis and Survival from Esophageal Adenocarcinoma: A Single Center VA Experience

Purpose: To determine and compare the effect of aspirin (ASA), proton pump inhibitors (PPI) and prior endoscopy on stage and outcomes of esophageal adenocarcinoma (EAC). Methods: Retrospective chart review was performed for patients who were diagnosed with EAC between 2000 and 2010 at our institution. Details including but not limited to demographics, other medical conditions, risk factors, use of ASA and/or PPI, prior endoscopy, stage of tumor, treatment and survival were obtained. Univariate and multivariate analysis were performed on available data using SPSS 20.0. Results: We found 108 patients with new diagnosis of EAC [mean age 65 years, 82 % Caucasians, 107 males]. Prior to the diagnosis, 54 % (n = 59) of patients were on PPIs and 23 % (n = 25) were on ASA for at least 6 months while 22 % (n = 24) had prior endoscopies. Patients using PPIs for at least 6 months were 59% less likely to die (OR 0.41, CI 0.17-0.96; p value: 0.04) and patients using ASA for at least 6 months were 56% less likely to die (OR 0.44, CI 0.12-1.11; p value: 0.08) at the end of one year from initial diagnosis when compared to patients not using PPIs and/or ASA. Patients with prior endoscopy were 92% less likely to die in one year of diagnosis (OR 0.08, CI: .01-0.74; p=0.03). Additionally, patients using PPIs for at least 6 months had one stage earlier (TNM) at diagnosis as compared to those who were not on PPIs (OR 0.28, CI 0.11-0.72; p value 0.008). Similar observation of an earlier TNM staging was seen with ASA use but it did not meet statistical significance (OR 0.78, CI 0.289-2.099; p value 0.621). Patients with prior endoscopy had one stage earlier at diagnosis (OR 0.05, CI: 0.002-1.15; p=0.06) Controlling for covariates, beneficial effects of ASA and PPIs were lost but those of prior endoscopy were persistent. Patients with prior endoscopies were diagnosed one TNM stage earlier than those without prior endoscopies (OR 0.26, CI: 0.16-0.40; p value: 0.00). Also, those who had prior endoscopies were more likely to survive more than one year from EAC diagnosis (OR 0.64, CI 0.50-0.85; p value 0.001). Conclusion: Prior endoscopy has the most robust association with an earlier TNM stage at diagnosis and decreased mortality at the end of one year from initial diagnosis of EAC. PPI use (statistically significant) and ASA use (statistically non-significant) for at least 6 months before diagnosis of EAC were also associated with earlier stage at diagnosis and decreased mortality at the end of one year.