Adenocarcinoma of the Esophagus in the Young
Arzu Oezcelik*, Steven R. Demeester, Shahin Ayazi, Emmanuele Abate, Joerg Zehetner, Jessica M. Leers, Jeffrey a. Hagen, John C. Lipham, Helen J. Sohn, Tom R. Demeester
Surgery, Keck School of Medicine, University of Southern California, Los Angeles/, CA
INTRODUCTION: A striking increase in the number of patients with esophageal adenocarcinoma in their 20’s and 30’s has caught the attention of practitioners. The aim of this study was to characterize the clinical presentation, management, and outcome of these young patients.METHODS: The records of all patients who presented between 2000 and 2007 with esophageal adenocarcinoma at our center were retrospectively reviewed. The stage, treatment and outcome in patients younger than 40 years were compared to that in patients ≥ 40 years old. RESULTS: Out of 374 patients, 20 (5%) were under the age of 40 years. There were 2 patients in their 20’s and 18 patients in their 30’s with the youngest being 25 years old. The median time between onset of symptoms and diagnosis in these patients was 3 month (IQR 2-5). Patients <40 years old with esophageal cancer have significantly more stage IV disease with significantly shorter time to recurrence (9.5 vs.19 month, p=0.002) compared to patients ≥40 years old (Table). The overall survival is worse in young patients (14 vs. 34 month, p=0.04).CONCLUSION(S): Esophageal adenocarcinoma in young patients tends to present at an advanced stage and is associated with a poor overall survival. This may be related to a low index of suspicion for warning symptoms in young patients that leads to a delay in diagnosis. Efforts at early detection and surveillance of Barrett’s will be important to improve survival in these patients.
Comparison between patients under the age of 40 years and patients 40 years of age and older with esophageal adenocarcinoma
| Patients < 40 years | Patients ≥ 40 years | p-value | |
| n | 20 | 352 | |
| Median age (IQR) | 37 | 66 | |
| Neoadjuvant | 8 (40%) | 80 (23%) | 0.07 |
| Stage I* | 0 | 105 (30%) | 0.003 |
| Stage II* | 1 (5%) | 51 (14%) | 0.4 |
| Stage III* | 8 (40%) | 103 (29%) | 0.04 |
| Stage IV* | 3 (15%) | 13 (4%) | 0.003 |
| Median survival | 17 month | 43 month | 0.04 |
*pathologic stage, patients with neoadjuvant therapy excluded
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