Changes in Age, Stage Distribution, and Survival of Patients with Esophageal Adenocarcinoma over Three Decades in the United States (original) (raw)

Abstract

Background

Our aim was to evaluate the changes in age, stage distribution, and overall survival (OS) of patients with esophageal adenocarcinoma (EAC) over time.

Methods

Patients from the Surveillance, Epidemiology, and End Results (SEER) database aged ≥20 with invasive EAC, diagnosed from 1973–2003 were reviewed. Survival follow-up ended in 2006.

Results

There were 11,620 patients; 6580 (57%) aged ≥65. The stage distribution was 22%, 35%, and 43% for localized, regional, and distant metastasis for patients aged <65, and 33%, 33%, and 34% for patients aged ≥65. The number of patients ≥65 years with localized stage increased over time. Three-year OS for localized, regional, and distant disease increased from 19%, 10%, and 1% in 1973–1976, to 34%, 13%, and 2% in 1987–1991, and to 45%, 25%, and 4% in 2002–2003 (P < 0.001). A sub-analysis of 5475 patients from 1988–2002 showed better survival for patients with esophagectomy for all stages. Three-year OS for 2074 patients with esophagectomy improved every 5 years from 1988–2002 (39%, 43% to 54%, P < 0.001). Stratified by stage, year and esophagectomy status, patients aged <65 had better survival compared to patients aged ≥65 (P < 0.001).

Conclusions

There has been a substantial improvement in overall survival among patients with invasive EAC over the last 3 decades. Patients receiving esophagectomy had longer survival. Survival with esophagectomy improved in each time period. Although younger EAC patients were diagnosed at more advanced stages over time, they had better survival.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst. 2008;100:1184–7.
    Article PubMed Google Scholar
  2. Trivers KF, Sabatino SA, Stewart SL. Trends in esophageal cancer incidence by histology, United States, 1998–2003. Int J Cancer. 2008;123:1422–8.
    Article PubMed CAS Google Scholar
  3. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.
    Article PubMed Google Scholar
  4. Cen P, Correa AM, Lee JH, et al. Adenocarcinoma of the lower esophagus with Barrett’s esophagus or without Barrett’s esophagus: differences in patients’ survival after preoperative chemoradiation. Dis Esophagus. 2009;22:32–41.
    Article PubMed CAS Google Scholar
  5. Zehetner J, Lipham JC, Ayazi S, et al. Esophagectomy for cancer in octogenarians. Dis Esophagus. 2010;23:666–9.
    Article PubMed CAS Google Scholar
  6. Hankey BF, Ries LA, Edwards BK. The Surveillance, Epidemiology, and End Results Program: a national resource. Cancer Epidemiol Biomarkers Prev. 1999;8:1117–21.
    PubMed CAS Google Scholar
  7. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg. 1980;67:381–90.
    CAS Google Scholar
  8. Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of oesophageal carcinoma. Br J Surg. 1990;77:845–57.
    Article PubMed CAS Google Scholar
  9. Jamieson GG, Mathew G, Ludemann R, Wayman J, Myers JC, Devitt PG. Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg. 2004;91:943–7.
    Article PubMed CAS Google Scholar
  10. Sihvo EI, Luostarinen ME, Salo JA. Fate of patients with adenocarcinoma of the esophagus and the esophagogastric junction: a population-based analysis. Am J Gastroenterol. 2004;99:419–24.
    Article PubMed Google Scholar
  11. Hofstetter W, Swisher SG, Correa AM, et al. Treatment outcomes of resected esophageal cancer. Ann Surg. 2002;236:376–84.
    Article PubMed Google Scholar
  12. Portale G, Peters JH, Hsieh CC, et al. Esophageal adenocarcinoma in patients < or = 50 years old: delayed diagnosis and advanced disease at presentation. Am Surg. 2004;70:954–8.
    PubMed CAS Google Scholar
  13. Ruol A, Castoro C, Portale G, et al. Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution. Arch Surg. 2009;144:247–54.
    Article PubMed Google Scholar
  14. Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg. 2001;234:581–7.
    Article PubMed CAS Google Scholar
  15. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.
    Article PubMed Google Scholar
  16. Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363–72.
    Article PubMed Google Scholar
  17. Vallbohmer D, Holscher AH, DeMeester S, et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer. Ann Surg. 2010;252:744–9.
    Article PubMed CAS Google Scholar
  18. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.
    Article PubMed Google Scholar
  19. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.
    Article PubMed Google Scholar
  20. Swisher SG, Deford L, Merriman KW, et al. Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2000;119:1126–32.
    Article PubMed CAS Google Scholar
  21. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.
    Article PubMed CAS Google Scholar
  22. Matthews HR, Powell DJ, McConkey CC. Effect of surgical experience on the results of resection for oesophageal carcinoma. Br J Surg. 1986;73:621–3.
    Article PubMed CAS Google Scholar
  23. Dimick JB, Pronovost PJ, Heitmiller RF, Lipsett PA. Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med. 2001;29:753–8.
    Article PubMed CAS Google Scholar
  24. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–94.
    PubMed Google Scholar
  25. Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233:338–44.
    Article PubMed CAS Google Scholar
  26. Kohn GP, Galanko JA, Meyers MO, Feins RH, Farrell TM. National trends in esophageal surgery—are outcomes as good as we believe? J Gastrointest Surg. 2009;13:1900–10.
    Article PubMed Google Scholar
  27. Hashemi N, Loren D, DiMarino AJ, Cohen S. Presentation and prognosis of esophageal adenocarcinoma in patients below age 50. Dig Dis Sci. 2009;54:1708–12.
    Article PubMed Google Scholar
  28. Hamouda A, Forshaw M, Rohatgi A, Mirnezami R, Botha A, Mason R. Presentation and survival of operable esophageal cancer in patients 55 years of age and below. World J Surg. 2010;34:744–9.
    Article PubMed CAS Google Scholar
  29. Jatoi A, Foster NR, Egner JR, et al. Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol. 2010;36:601–6.
    Article PubMed CAS Google Scholar

Download references

Acknowledgment

We thank Dr. Sheri Skinner and Marika Stepankiw for editorial assistance.

Author information

Authors and Affiliations

  1. Division of Oncology, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA
    Putao Cen MD & Robert J. Amato DO
  2. Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, TX, USA
    Farzaneh Banki MD, Kamal Khalil & Larry R. Kaiser MD
  3. Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
    Lee Cheng MD
  4. Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
    Xianglin L. Du MD, PhD
  5. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA
    Michael Fallon MD

Authors

  1. Putao Cen MD
    You can also search for this author inPubMed Google Scholar
  2. Farzaneh Banki MD
    You can also search for this author inPubMed Google Scholar
  3. Lee Cheng MD
    You can also search for this author inPubMed Google Scholar
  4. Kamal Khalil
    You can also search for this author inPubMed Google Scholar
  5. Xianglin L. Du MD, PhD
    You can also search for this author inPubMed Google Scholar
  6. Michael Fallon MD
    You can also search for this author inPubMed Google Scholar
  7. Robert J. Amato DO
    You can also search for this author inPubMed Google Scholar
  8. Larry R. Kaiser MD
    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence toPutao Cen MD.

Rights and permissions

About this article

Cite this article

Cen, P., Banki, F., Cheng, L. et al. Changes in Age, Stage Distribution, and Survival of Patients with Esophageal Adenocarcinoma over Three Decades in the United States.Ann Surg Oncol 19, 1685–1691 (2012). https://doi.org/10.1245/s10434-011-2141-1

Download citation

Keywords