TY - JOUR
T1 - Diabetes in relation to Barrett's esophagus and adenocarcinomas of the esophagus
T2 - A pooled study from the International Barrett's and Esophageal Adenocarcinoma Consortium
AU - Petrick, Jessica L.
AU - Li, Nan
AU - Anderson, Lesley A.
AU - Bernstein, Leslie
AU - Corley, Douglas A.
AU - El Serag, Hashem B.
AU - Hardikar, Sheetal
AU - Liao, Linda M.
AU - Liu, Geoffrey
AU - Murray, Liam J.
AU - Rubenstein, Joel H.
AU - Schneider, Jennifer L.
AU - Shaheen, Nicholas J.
AU - Thrift, Aaron P.
AU - van den Brandt, Piet A.
AU - Vaughan, Thomas L.
AU - Whiteman, David C.
AU - Wu, Anna H.
AU - Zhao, Wei K.
AU - Gammon, Marilie D.
AU - Cook, Michael B.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear. Methods Data were harmonized across 13 studies in the International Barrett's and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric junction adenocarcinoma (EGJA) cases, 1728 Barrett's esophagus (BE) cases, and 16,354 controls. Logistic regression was used to estimate study-specific odds ratios (ORs) and 95% CIs for self-reported diabetes in association with EA, EGJA, and BE. Adjusted ORs were then combined using random-effects meta-analysis. Results Diabetes was associated with a 34% increased risk of EA (OR, 1.34; 95% CI, 1.00-1.80; I-2 = 48.8% [where 0% indicates no heterogeneity, and larger values indicate increasing heterogeneity between studies]), 27% for EGJA (OR, 1.27; 95% CI, 1.05-1.55; I-2 = 0.0%), and 30% for EA/EGJA combined (OR, 1.30; 95% CI, 1.06-1.58; I-2 = 34.9%). Regurgitation symptoms modified the diabetes-EA/EGJA association (P for interaction = .04) with a 63% increased risk among participants with regurgitation (OR, 1.63; 95% CI, 1.19-2.22), but not among those without regurgitation (OR, 1.03; 95% CI, 0.74-1.43). No consistent association was found between diabetes and BE. Conclusions Diabetes was associated with increased EA and EGJA risk, which was confined to individuals with regurgitation symptoms. Lack of an association between diabetes and BE suggests that diabetes may influence progression of BE to cancer.
AB - Background Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear. Methods Data were harmonized across 13 studies in the International Barrett's and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric junction adenocarcinoma (EGJA) cases, 1728 Barrett's esophagus (BE) cases, and 16,354 controls. Logistic regression was used to estimate study-specific odds ratios (ORs) and 95% CIs for self-reported diabetes in association with EA, EGJA, and BE. Adjusted ORs were then combined using random-effects meta-analysis. Results Diabetes was associated with a 34% increased risk of EA (OR, 1.34; 95% CI, 1.00-1.80; I-2 = 48.8% [where 0% indicates no heterogeneity, and larger values indicate increasing heterogeneity between studies]), 27% for EGJA (OR, 1.27; 95% CI, 1.05-1.55; I-2 = 0.0%), and 30% for EA/EGJA combined (OR, 1.30; 95% CI, 1.06-1.58; I-2 = 34.9%). Regurgitation symptoms modified the diabetes-EA/EGJA association (P for interaction = .04) with a 63% increased risk among participants with regurgitation (OR, 1.63; 95% CI, 1.19-2.22), but not among those without regurgitation (OR, 1.03; 95% CI, 0.74-1.43). No consistent association was found between diabetes and BE. Conclusions Diabetes was associated with increased EA and EGJA risk, which was confined to individuals with regurgitation symptoms. Lack of an association between diabetes and BE suggests that diabetes may influence progression of BE to cancer.
KW - Barrett esophagus
KW - diabetes
KW - epidemiology
KW - esophageal adenocarcinoma
KW - meta-analysis
KW - BODY-MASS INDEX
KW - ANTIINFLAMMATORY DRUG-USE
KW - GASTROESOPHAGEAL-REFLUX
KW - ESOPHAGOGASTRIC JUNCTION
KW - INCREASING INCIDENCE
KW - METABOLIC SYNDROME
KW - GASTRIC CARDIA
KW - UNITED-STATES
KW - RISK-FACTORS
KW - GASTROINTESTINAL MOTOR
U2 - 10.1002/cncr.32444
DO - 10.1002/cncr.32444
M3 - Article
C2 - 31490550
VL - 125
SP - 4210
EP - 4223
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 23
ER -