PROJECT SUMMARY Although esophageal adenocarcinoma (EAC) is a relatively uncommon cancer, the incidence of this disease has increased rapidly in recent decades; moreover, at the time of detection of EA, most patients have very poor prognosis. The alarming increase in EA over the past several decades, along with the poor prognosis for those affected, demand investigation into the risk factors for this disease, improved management of patients at risk, and development of preventive measures. Advances in these areas will have significant public health benefit in terms of reducing morbidity and mortality for those affected, as well as reducing the public health costs associated with managing EA at advanced stages. To better manage patients at risk for EA will require an improved understanding of the mechanisms of neoplastic progression in the esophagus. Such progression involves the development of Barrett's esophagus, a premalignant lesion in which the normal stratified squamous epithelium of the distal esophagus is replaced by columnar epithelium, visible as an abnormality on endoscopy, and confirmed on biopsy as specialized columnar epithelium with intestinal metaplasia. For these reasons, the NCI has developed the Barrett's Esophagus Translational Research Network (BETRNet), a consortium research initiative with the goal of reducing the incidence, morbidity, and mortality of EAC, through answering key questions related to the progression of this disease, especially in the premalignant stage of BE, the only precursor lesion definitively associated with EA. In this application we describe the accomplishments to date, as well as the vision forward, for the BETRNet Coordinating Center (BETRNet-CC), with the following critical functions: • Administrative and logistical support for the BETRNet program, including efficient communications and coordination of efforts to connect available resources, serve as a data management center, and integrate activities of the research centers; • Coordination of cross-network research through leadership and management of diverse teams, as well as providing logistical and administrative support to the governing body of the BETRNet (the Steering Committee); and • Ongoing development, maintenance, and administration of the BETRNet patient registry with virtual biorepository (BETRNet PR-VB).

PROJECT NARRATIVE The incidence of esophageal adenocarcinoma (EAC) has increased rapidly in recent decades; at the time of detection of EA, most patients have very poor prognosis. To better manage patients at risk for EA will require an improved understanding of the mechanisms of neoplastic progression in the esophagus. The Barrett's Esophagus Translational Research Network (BETRNet) is a consortium research initiative with the goal of reducing the incidence, morbidity, and mortality of EAC; the BETRNet Coordinating Center (BETRNet-CC) has a key role to play in the success of the BETRNet and consequent improvement in outcomes for patients at risk for EAC.