|
Back to 2015 Annual Meeting Program
the Evolving Landscape of Esophageal Cancer: a Four Decade Analysis
Robert Klein, Richard Klein, Carrie E. Ryan, Benjamin Sadowitz, Prashant Sukharamwala, Sharona B. Ross, Alexander S. Rosemurgy*
General Surgery, Florida Hospital Tampa, Tampa, FL
Introduction: There is a perception that the incidence of esophageal cancer is rising and evolving in cell type. This study was undertaken to determine changes in the incidence, cell type, and presenting stage of esophageal cancer over the past 40 years.
Methods: Utilizing the SEER database, all patients with esophageal cancer between 1973 and 2010 were identified and their cancers were stratified by cell type and presenting stage. Data on incidence and stage at diagnosis were collected. Data were analyzed using linear regression. Significance was accepted at p ≤ 0.05.
Results: Since 1973 there has been an 8-fold increase in the number of patients with esophageal cancer (r=0.9, p<0.0001). While squamous cell cancers have increased 3-fold, they have relatively decreased in incidence due to a 52-fold increase in adenocarcinoma, especially in the distal esophagus (r=0.98, p≤0.0001). Unlike for squamous cell carcinoma, stage of presentation for adenocarcinoma has progressively decreased, with 25% of patients now presenting with localized disease (p ≤ 0.0001).
Conclusion: There has been a notable increase in esophageal cancer over the past 40 years. This increase is the result of a dramatic, even alarming, increase in adenocarcinoma of the esophagus. Patients with adenocarcinoma are presenting at an earlier stage, but only in a minority of patients, with potential implications of a better prognosis. While many factors undoubtedly play a role in the "epidemic" of adenocarcinoma of the esophagus (especially the distal esophagus), GERD and the widespread application of H-2 blockers and, more recently, PPIs must be evaluated as causative agents. Furthermore, surgeons must be fully prepared to offer the full spectrum of operations for esophageal diseases including cancer.
Back to 2015 Annual Meeting Program
|
