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 Results database was queried to identify patients with confirmed EC. Cox proportional hazard regression was used to determine independent mortality factors. Results:Of 93167 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=46683; 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 (6months versus 10months, 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.