Age-related outcomes in patients with esophageal cancer: A propensity score matched analysis.

Abstract

326 Background: Esophageal cancer is increasing in incidence worldwide. It is estimated that there will be 17,650 new cases of esophageal cancer diagnosed, with 16,080 dying from the disease in the United States in 2019. There has been an increase in younger patients diagnosed with esophageal cancer. We sought to evaluate the outcomes in younger patients diagnosed with esophageal cancer. Methods: Utilizing the National Cancer Database we identified patients with esophageal cancer. We then stratified by age < 50, 51-60, 61-70, and > 70 years. Baseline univariate comparisons were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. All statistical tests were two-sided and p < 0.05 was significant. Propensity score matched analysis was performed and only exact matches were allowed. Results: We identified 20,324 patients ( < 50, 2157), (51-60, 5387), (61-70, 7853), and ( > 70, 4927). T-stages and N stages were higher in the younger age groups p < 0.001 and p < 0.001 respectively. Median lymph nodes positive were highest in the < 50 group (2.2 vs 1.8 vs 1.6 vs 1.7) p < 0.001. Additionally, tumor size was largest in this age cohort (3.7 vs 3.5 vs 3.5 vs 3.2) p = 0.002. Neoadjuvant therapy was administered in 69.4% of patients in the < 50, 68.5% (51-60), 65.5% (61-70), and 49.5% > 70 patients, p < 0.001. The < 50 age group was however more likely to receive adjuvant therapy (22.9% vs 20.5% vs 16.9% vs 13.4%) p < 0.001. Median and overall survival was 49.8 mo and 45% ( < 50), 45.4mo and 43% (51-60), 45.4mo and 43% (61-70), and 35.8mo and 39% > 70, p < 0.001. After propensity score matching, multivariate analysis found that age < 50, male gender, GEJ tumor location, grade, Charleson Deyo score, T-stage N stage, margin, facility volume, neoadjuvant and adjuvant therapy were predictors of survival. Conclusions: Although younger patients present with larger tumors, higher T-stages, and N stages, they are more likely to receive neoadjuvant and adjuvant therapies. It is these therapies which are most likely contributing to improved survival compared to their older counterparts.