Esophageal cancer in young patients: Is aggressive treatment associated with better outcomes?

Abstract

54 Background: Recent studies suggest that survival in young patients with esophageal cancer (EC) is worse than their older counterpart, secondary theoretically to more aggressive disease and late stage at diagnosis. The aim of this study is to compare stage at diagnosis, patterns of treatment and outcomes of young patients with EC at Moffitt Cancer Center (MCC). Methods: Patients with EC treated surgically between 1996 and 2014 at MCC were recorded at an IRB approved database. We divided the patients into two cohorts, those younger or older than 50 years of age. Demographics, pre-treatment clinical data, therapeutic courses and treatment outcomes were analyzed. We compared clinical variables and defined p < 0.05 as statistically significant. Overall survival was examined using the Kaplan-Meier method. Results: Of the 816 patients treated surgically for EC 86 (10.5%) were < 50 years old. The majority of patients were male 622(85.2%) vs. 67(77.9%) in the younger group (p =.084). Of the 816 patients, 569 had pre-treatment staging information available. Pre-treatment clinical staging for the older and younger cohorts was, Stage0/TIS = 13(2.2%) vs. 1(1.4%); Stage I = 90(15.3%) vs. 6(8.3%); Stage IIA = 119(20.3%) vs. 16(22.2%); Stage IIB = 88(15.0%) vs. 8(11.1%); Stage III = 269(46%) vs. 40(55%); Stage IV = 8(1.4%) vs. 1(1.3%)(p =.44). Younger patients were more likely to receive neoadjuvant therapy (75.6% vs.62.1%)(p =.013), and also neoadjuvant combined with adjuvant therapy, 24(41.4%) compared to 48(12.1%) in the older cohort (p =.001). Pathological complete response (pCR) rate was higher in older patients (43.2% vs 32%)(p =.204); Median survival was higher in younger cohort 64.3 vs. 56.4 months. Neither of these were statically significant (p =.516). Conclusions: This retrospective study with several variables only included surgical patients. In our experience, younger age was not associated with late stage presentation. Younger patients were more likely to be treated with neoadjuvant therapy, and despite similar pathologic response rates they were more likely to receive adjuvant therapy. Although younger patients received more aggressive treatment, their overall survival did not differ from their older counterparts.