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Esophageal Cancer in the Young: a Population-Based Analysis of 1,095 Patients
Attila Dubecz*1, Norbert Solymosi2, Michael Schweigert1, Jeffrey H. Peters3, Hubert J. Stein1
1Surgery, Klinikum Nurnberg, Nurnberg, Germany; 2Faculty of Veterinary Science, Szent Istvan University, Budapest, Hungary; 3Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
BACKGROUND:
Controversy exists about the clinical presentation and prognosis of young patients with gastrointestinal malignancies. The aim of this study was to evaluate population-based demographics and survival of young patients with esophageal cancer in the United States.
METHODS:
We identified 1,095 patients under 40 years of age with cancer of the esophagus and the
gastric cardia diagnosed between 1973 and 2008 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic variables and cancer-related survival were assessed and compared to all patients >40 years old (n= 65,930). Influence of available variables on survival was analyzed with logistic regression.
RESULTS:
Percentage of young patients with esophageal cancer is less than 2% and is declining since the 1990s. More than fifty percent are diagnosed in metastatic stage. Only 74% of patients with potentially resectable esophageal cancer underwent surgery. Median cancer-related survival (13 months vs. 11months) and five-year survival (22% vs. 18%) was significantly higher than in older patients. Multivariate-analysis identified surgical treatment (OR: 5.046) as the only as independent predictor of 5-year survival. Percentage of non-white patients, distal cancer and adenocarcinoma were significantly higher when compared to all patients.
CONCLUSION:
Most young patients with esophageal cancer are diagnosed in metastatic stage in the United States. Survival in patients under 40 years of age is better than in older patients. Patients undergoing surgical treatment for locoregional cancer have better survival.
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