Changes in age, stage distribution, and survival of patients with esophageal adenocarcinoma over three decades in the United States

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 subanalysis 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.