S933 Comparative Outcomes of GE Junction Cancer in Patients With Barrett's Esophagus versus GERD: A Real-World Data Analysis Using the TriNetX Network

Introduction: Barrett’s esophagus (BE) is a known precursor to esophageal adenocarcinoma, yet the differential risk of gastroesophageal (GE) junction cancer in BE versus gastroesophageal reflux disease (GERD) without BE remains underexplored. This study aims to leverage a large multi-institutional database to assess the comparative incidence and outcomes of GE junction malignancies among these populations. Methods: A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network database comprising 69 healthcare organizations. Adults (≥18 years) with BE (Cohort 1, N = 397,409) or GERD without BE (Cohort 2, N = 9,824,193) were identified using International Classification of Diseases CD-10 codes. After 1:1 propensity score matching for demographics, diagnoses, and medications, each cohort included 391,695 patients. Outcomes analyzed included GE junction cancer, 5-year mortality, metastases, and chemotherapy use. Measures of association and Kaplan-Meier survival analyses were performed. Results: Incidence of GE junction cancer was significantly higher in the BE cohort (1.9%) compared to GERD (0.3%), with a risk ratio of 5.86 (95% confidence interval [CI] 5.52-6.21; P < 0.001). Kaplan-Meier analysis showed lower survival probability in BE patients (96.37% vs 99.37%; P < 0.001). Five-year mortality was slightly lower in BE (10.5%) versus GERD (11.4%) with a hazard ratio (HR) of 0.84 (95% CI 0.83-0.85; P < 0.001). Metastatic disease was also slightly lower in BE (3.2% vs 3.7%; HR: 0.82; P < 0.001). Chemotherapy use was marginally lower in BE (0.8% vs 0.9%; HR: 0.85; P < 0.001). Conclusion: Patients with BE have a markedly higher risk of developing GE junction cancer compared to those with GERD alone, underscoring the need for vigilant surveillance. Interestingly, BE patients showed slightly better long-term survival outcomes and lower rates of metastases and chemotherapy utilization, warranting further investigation into disease biology and treatment patterns.