Trends in esophageal cancer survival in United States adults from 1973 to 2009: A SEER database analysis

Background and Aim: The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long‐term survival and impact on modern therapies associated with survival are lacking. Methods: The Surveillance, Epidemiology, and End Resu...

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Published in:	Journal of gastroenterology and hepatology Vol. 31; no. 6; pp. 1141 - 1146
Main Authors:	Njei, Basile, McCarty, Thomas R, Birk, John W
Format:	Journal Article
Language:	English
Published:	Australia Blackwell Publishing Ltd 01.06.2016
Subjects:	adenocarcinoma Adenocarcinoma - diagnosis Adenocarcinoma - mortality Adenocarcinoma - therapy Age Factors Aged carcinoma Carcinoma, Squamous Cell - diagnosis Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - therapy Early Detection of Cancer Esophageal Neoplasms - diagnosis Esophageal Neoplasms - mortality Esophageal Neoplasms - therapy Esophagectomy - trends esophagus Female Humans Kaplan-Meier Estimate Male Middle Aged Multivariate Analysis Neoplasm Staging Predictive Value of Tests Proportional Hazards Models Retrospective Studies Risk Factors SEER Program squamous Survival Rate - trends Time Factors Treatment Outcome United States adenocarcinoma squamous carcinoma esophagus
ISSN:	0815-9319, 1440-1746, 1440-1746
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Abstract	Background and Aim: The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long‐term survival and impact on modern therapies associated with survival are lacking. Methods: The Surveillance, Epidemiology, and End Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors. Results: Of 93 167 patients diagnosed with EC between 1973 and 2009, 49% had a histologic diagnosis of esophageal adenocarcinoma (EAC). There was an increase (almost double) in the proportion of patients with adenocarcinoma from the 1970s to 2000s (n = 2,350; 35% to n = 32,212; 61%, P < 0.001). Surgery was performed for localized disease in a majority of EC regardless of type (n = 46 683; 89%). Use of surgical treatment increased significantly over the study period (49% to 64%, P < 0.001). There was also an increase in overall median survival (6 months versus 10 months, P < 0.001) and 5‐year survival rate (9% to 22%, P < 0.001). Median survival increased consistently for EAC and squamous cell carcinoma (SCC) until the 1990s. After this period, median survival of EAC continued to increase more rapidly while SCC remained relatively stable. Conclusion: A significant survival improvement in esophageal cancer was seen from 1973 to 2009, largely because of earlier detection at a curative stage and greater utilization of treatment modalities (especially surgery). Despite the rising prevalence, patients with EAC have better long‐term survival outcomes than those SCC.
AbstractList	Background and Aim: The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long‐term survival and impact on modern therapies associated with survival are lacking. Methods: The Surveillance, Epidemiology, and End Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors. Results: Of 93 167 patients diagnosed with EC between 1973 and 2009, 49% had a histologic diagnosis of esophageal adenocarcinoma (EAC). There was an increase (almost double) in the proportion of patients with adenocarcinoma from the 1970s to 2000s (n = 2,350; 35% to n = 32,212; 61%, P < 0.001). Surgery was performed for localized disease in a majority of EC regardless of type (n = 46 683; 89%). Use of surgical treatment increased significantly over the study period (49% to 64%, P < 0.001). There was also an increase in overall median survival (6 months versus 10 months, P < 0.001) and 5‐year survival rate (9% to 22%, P < 0.001). Median survival increased consistently for EAC and squamous cell carcinoma (SCC) until the 1990s. After this period, median survival of EAC continued to increase more rapidly while SCC remained relatively stable. Conclusion: A significant survival improvement in esophageal cancer was seen from 1973 to 2009, largely because of earlier detection at a curative stage and greater utilization of treatment modalities (especially surgery). Despite the rising prevalence, patients with EAC have better long‐term survival outcomes than those SCC. The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long-term survival and impact on modern therapies associated with survival are lacking. The Surveillance, Epidemiology, and End Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors. Of 93 167 patients diagnosed with EC between 1973 and 2009, 49% had a histologic diagnosis of esophageal adenocarcinoma (EAC). There was an increase (almost double) in the proportion of patients with adenocarcinoma from the 1970s to 2000s (n = 2,350; 35% to n = 32,212; 61%, P < 0.001). Surgery was performed for localized disease in a majority of EC regardless of type (n = 46 683; 89%). Use of surgical treatment increased significantly over the study period (49% to 64%, P < 0.001). There was also an increase in overall median survival (6 months versus 10 months, P < 0.001) and 5-year survival rate (9% to 22%, P < 0.001). Median survival increased consistently for EAC and squamous cell carcinoma (SCC) until the 1990s. After this period, median survival of EAC continued to increase more rapidly while SCC remained relatively stable. A significant survival improvement in esophageal cancer was seen from 1973 to 2009, largely because of earlier detection at a curative stage and greater utilization of treatment modalities (especially surgery). Despite the rising prevalence, patients with EAC have better long-term survival outcomes than those SCC. The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long-term survival and impact on modern therapies associated with survival are lacking.BACKGROUND AND AIMThe rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long-term survival and impact on modern therapies associated with survival are lacking.The Surveillance, Epidemiology, and End Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors.METHODSThe Surveillance, Epidemiology, and End Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors.Of 93 167 patients diagnosed with EC between 1973 and 2009, 49% had a histologic diagnosis of esophageal adenocarcinoma (EAC). There was an increase (almost double) in the proportion of patients with adenocarcinoma from the 1970s to 2000s (n = 2,350; 35% to n = 32,212; 61%, P < 0.001). Surgery was performed for localized disease in a majority of EC regardless of type (n = 46 683; 89%). Use of surgical treatment increased significantly over the study period (49% to 64%, P < 0.001). There was also an increase in overall median survival (6 months versus 10 months, P < 0.001) and 5-year survival rate (9% to 22%, P < 0.001). Median survival increased consistently for EAC and squamous cell carcinoma (SCC) until the 1990s. After this period, median survival of EAC continued to increase more rapidly while SCC remained relatively stable.RESULTSOf 93 167 patients diagnosed with EC between 1973 and 2009, 49% had a histologic diagnosis of esophageal adenocarcinoma (EAC). There was an increase (almost double) in the proportion of patients with adenocarcinoma from the 1970s to 2000s (n = 2,350; 35% to n = 32,212; 61%, P < 0.001). Surgery was performed for localized disease in a majority of EC regardless of type (n = 46 683; 89%). Use of surgical treatment increased significantly over the study period (49% to 64%, P < 0.001). There was also an increase in overall median survival (6 months versus 10 months, P < 0.001) and 5-year survival rate (9% to 22%, P < 0.001). Median survival increased consistently for EAC and squamous cell carcinoma (SCC) until the 1990s. After this period, median survival of EAC continued to increase more rapidly while SCC remained relatively stable.A significant survival improvement in esophageal cancer was seen from 1973 to 2009, largely because of earlier detection at a curative stage and greater utilization of treatment modalities (especially surgery). Despite the rising prevalence, patients with EAC have better long-term survival outcomes than those SCC.CONCLUSIONA significant survival improvement in esophageal cancer was seen from 1973 to 2009, largely because of earlier detection at a curative stage and greater utilization of treatment modalities (especially surgery). Despite the rising prevalence, patients with EAC have better long-term survival outcomes than those SCC.
Author	Birk, John W Njei, Basile McCarty, Thomas R
AuthorAffiliation	3 Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA 2 Department of Medicine, Division of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT, USA
AuthorAffiliation_xml	– name: 3 Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA – name: 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA – name: 2 Department of Medicine, Division of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT, USA
Author_xml	– sequence: 1 givenname: Basile surname: Njei fullname: Njei, Basile email: basile.njei@yale.edu organization: Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA – sequence: 2 givenname: Thomas R surname: McCarty fullname: McCarty, Thomas R organization: Section of Digestive Diseases, Yale University School of Medicine, Connecticut, New Haven, USA – sequence: 3 givenname: John W surname: Birk fullname: Birk, John W organization: Department of Medicine, Division of Gastroenterology and Hepatology, University of Connecticut, Connecticut, Farmington, USA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26749521$$D View this record in MEDLINE/PubMed
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Keywords	adenocarcinoma squamous carcinoma esophagus
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International classification of diseases for oncology, 3rd edn. 2000. Chang DT, Chapman C, Shen J, Su Z, Koong AC. Treatment of esophageal cancer based on histology: a surveillance epidemiology and end results analysis. Am. J. Clin. Oncol. 2009; 32: 405-10. Lagergren J. Any role for endoscopy screening or surveillance for esophageal adenocarcinoma among persons with GERD? Gastrointest. Endosc. 2008; 68: 856-8. Hansson LE, Sparen P, Nyren O. Increasing incidence of both major histological types of esophageal carcinomas among men in Sweden. Int. J. Cancer 1993; 54: 402-7. Pohl H, Sirovich B, Welch HG. Esophageal adenocarcinoma incidence: are we reaching the peak? Cancer Epidemiol. Biomarkers Prev.: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2010; 19: 1468-70. Dubecz A, Gall I, Solymosi N et al. Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis. J. Thorac. 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National trends in esophageal surgery-are outcomes as good as we believe? J. Gastrointest. Surg.: official journal of the Society for Surgery of the Alimentary Tract 2009; 13: 1900-10; discussion 10-2. Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol. Biomarkers Prev.: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 1995; 4: 85-92. Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998; 83: 2049-53. Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL. Use of SEER-Medicare data for measuring cancer surgery. Med. Care 2002; 40: IV-43-8. El-Serag HB, Mason AC, Key C. 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References_xml	– reference: World Health Organization G. International classification of diseases for oncology, 3rd edn. 2000. – reference: Percy C, Van Holten V, Muir C, eds. International Classification of Diseases for Oncology, 2nd edn. Geneva: World Health Organization, 1990. – reference: Hur C, Miller M, Kong CY et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013; 119: 1149-58. – reference: El-Serag HB, Mason AC, Key C. Trends in survival of patients with hepatocellular carcinoma between 1977 and 1996 in the United States. Hepatology 2001; 33: 62-5. – reference: Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J. Clin. 2011; 61: 69-90. – reference: Bollschweiler E, Wolfgarten E, Gutschow C, Holscher AH. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001; 92: 549-55. – reference: Moyer LA, Boyle CA, Pollock DA. Validity of death certificates for injury-related causes of death. Am. J. Epidemiol. 1989; 130: 1024-32. – reference: Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J. Am. Stat. Assoc. 1958; 53: 457-81. – reference: Garidou A, Tzonou A, Lipworth L, Signorello LB, Kalapothaki V, Trichopoulos D. Life-style factors and medical conditions in relation to esophageal cancer by histologic type in a low-risk population. Int. J. Cancer 1996; 68: 295-9. – reference: Chang DT, Chapman C, Shen J, Su Z, Koong AC. Treatment of esophageal cancer based on histology: a surveillance epidemiology and end results analysis. Am. J. Clin. Oncol. 2009; 32: 405-10. – reference: Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med. Care 2002; 40: IV-3-18. – reference: Nathan H, Pawlik TM. Limitations of claims and registry data in surgical oncology research. Ann. Surg. Oncol. 2008; 15: 415-23. – reference: Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL. Use of SEER-Medicare data for measuring cancer surgery. Med. Care 2002; 40: IV-43-8. – reference: Agresti A. Introduction to categorical data analysis. New York: Wiley, 1996; 182-5 7-9, 201, 17, 79. – reference: Polednak AP. Trends in survival for both histologic types of esophageal cancer in US surveillance, epidemiology and end results areas. Int. J. Cancer 2003; 105: 98-100. – reference: 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.: official journal of the Society for Surgery of the Alimentary Tract 2009; 13: 1900-10; discussion 10-2. – reference: Roayaie S, Jibara G, Taouli B, Schwartz M. Resection of hepatocellular carcinoma with macroscopic vascular invasion. Ann. Surg. Oncol. 2013; 20: 3754-60. – reference: Bedenne L, Michel P, Bouche O et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J. Clin. Oncol. 2007; 25: 1160-8. – reference: Hansson LE, Sparen P, Nyren O. Increasing incidence of both major histological types of esophageal carcinomas among men in Sweden. Int. J. Cancer 1993; 54: 402-7. – reference: Cameron AJ, Lomboy CT, Pera M, Carpenter HA. Adenocarcinoma of the esophagogastric junction and Barrett's esophagus. Gastroenterology 1995; 109: 1541-6. – reference: 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. 2012; 19: 1685-91. – reference: Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998; 83: 2049-53. – reference: Pohl H, Sirovich B, Welch HG. Esophageal adenocarcinoma incidence: are we reaching the peak? Cancer Epidemiol. Biomarkers Prev.: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2010; 19: 1468-70. – reference: Wang KK, Sampliner RE, Practice Parameters Committee of the American College of G. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am. J. Gastroenterol. 2008; 103: 788-97. – reference: Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J. Clin. 2015; 65: 5-29. – reference: Falk GW, Ours TM, Richter JE. Practice patterns for surveillance of Barrett's esophagus in the United States. Gastrointest. Endosc. 2000; 52: 197-203. – reference: Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol. 2007; 8: 545-53. – reference: Fritz A, Percy C, Jack A et al., eds. International Classification of Diseases for Oncology, 3rd edn. Geneva: World Health Organization, 2000. – reference: Nordenstedt H, El-Serag H. The influence of age, sex, and race on the incidence of esophageal cancer in the United States (1992-2006). Scand. J. Gastroenterol. 2011; 46: 597-602. – reference: Enzinger PC, Mayer RJ. Esophageal cancer. N. Engl. J. Med. 2003; 349: 2241-52. – reference: Hofstetter W, Swisher SG, Correa AM et al. Treatment outcomes of resected esophageal cancer. Ann. Surg. 2002; 236: 376-84; discussion 84-5. – reference: Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J. Clin. 2012; 62: 118-28. – reference: Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol. Biomarkers Prev.: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 1995; 4: 85-92. – reference: Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265: 1287-9. – reference: Lagergren J. Any role for endoscopy screening or surveillance for esophageal adenocarcinoma among persons with GERD? Gastrointest. Endosc. 2008; 68: 856-8. – reference: Engel LS, Chow WH, Vaughan TL et al. Population attributable risks of esophageal and gastric cancers. J. Natl. Cancer Inst. 2003; 95: 1404-13. – reference: Trivers KF, Sabatino SA, Stewart SL. Trends in esophageal cancer incidence by histology, United States, 1998-2003. Int. J. Cancer 2008; 123: 1422-8. – reference: Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology 2005; 128: 1554-66. – reference: Dubecz A, Gall I, Solymosi N et al. Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis. J. Thorac. Oncol. 2012; 7: 443-7. – reference: Wolf MC, Stahl M, Krause BJ et al. Curative treatment of oesophageal carcinoma: current options and future developments. Radiat. Oncol. 2011; 6: 6-55. – reference: Fortner JG, Klimstra DS, Senie RT, Maclean BJ. Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy. Ann. Surg. 1996; 223: 147-53. – volume: 265 start-page: 1287 year: 1991 end-page: 9 article-title: Rising incidence of adenocarcinoma of the esophagus and gastric cardia publication-title: JAMA – volume: 92 start-page: 549 year: 2001 end-page: 55 article-title: Demographic variations in the rising incidence of esophageal adenocarcinoma in white males publication-title: Cancer – volume: 83 start-page: 2049 year: 1998 end-page: 53 article-title: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States publication-title: Cancer – volume: 8 start-page: 545 year: 2007 end-page: 53 article-title: Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities publication-title: Lancet Oncol. – volume: 128 start-page: 1554 year: 2005 end-page: 66 article-title: Advances in Barrett's esophagus and esophageal adenocarcinoma publication-title: Gastroenterology – volume: 61 start-page: 69 year: 2011 end-page: 90 article-title: Global cancer statistics publication-title: CA Cancer J. Clin. – year: 2000 – year: 1996 – volume: 53 start-page: 457 year: 1958 end-page: 81 article-title: Nonparametric estimation from incomplete observations publication-title: J. Am. Stat. Assoc. – volume: 54 start-page: 402 year: 1993 end-page: 7 article-title: Increasing incidence of both major histological types of esophageal carcinomas among men in Sweden publication-title: Int. J. Cancer – volume: 19 start-page: 1685 year: 2012 end-page: 91 article-title: Changes in age, stage distribution, and survival of patients with esophageal adenocarcinoma over three decades in the United States publication-title: Ann. Surg. Oncol. – volume: 33 start-page: 62 year: 2001 end-page: 5 article-title: Trends in survival of patients with hepatocellular carcinoma between 1977 and 1996 in the United States publication-title: Hepatology – volume: 130 start-page: 1024 year: 1989 end-page: 32 article-title: Validity of death certificates for injury‐related causes of death publication-title: Am. J. Epidemiol. – volume: 40 start-page: 3 year: 2002 end-page: 18 article-title: Overview of the SEER‐Medicare data: content, research applications, and generalizability to the United States elderly population publication-title: Med. Care – volume: 65 start-page: 5 year: 2015 end-page: 29 article-title: Cancer statistics, 2015 publication-title: CA Cancer J. Clin. – volume: 109 start-page: 1541 year: 1995 end-page: 6 article-title: Adenocarcinoma of the esophagogastric junction and Barrett's esophagus publication-title: Gastroenterology – volume: 13 start-page: 1900 year: 2009 end-page: 10 article-title: National trends in esophageal surgery—are outcomes as good as we believe? publication-title: J. Gastrointest. Surg. – volume: 68 start-page: 295 year: 1996 end-page: 9 article-title: Life‐style factors and medical conditions in relation to esophageal cancer by histologic type in a low‐risk population publication-title: Int. J. 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Snippet	Background and Aim: The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in... The rise in incidence of esophageal cancer (EC) in the USA over the last four decades has been well documented; however, data on trends in long-term survival...
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SubjectTerms	adenocarcinoma Adenocarcinoma - diagnosis Adenocarcinoma - mortality Adenocarcinoma - therapy Age Factors Aged carcinoma Carcinoma, Squamous Cell - diagnosis Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - therapy Early Detection of Cancer Esophageal Neoplasms - diagnosis Esophageal Neoplasms - mortality Esophageal Neoplasms - therapy Esophagectomy - trends esophagus Female Humans Kaplan-Meier Estimate Male Middle Aged Multivariate Analysis Neoplasm Staging Predictive Value of Tests Proportional Hazards Models Retrospective Studies Risk Factors SEER Program squamous Survival Rate - trends Time Factors Treatment Outcome United States
Title	Trends in esophageal cancer survival in United States adults from 1973 to 2009: A SEER database analysis
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