Abstract
ObjectivesThis study was performed to identify the differences in incidence, clinicopathological features, and survival in esophageal cancer among ethnic groups in the United States and to determine the reasons for the differences.ResultA total of 49,766 patients were included. Black and Asian groups had a higher proportion of squamous cell carcinoma (ESCC) (85.5% and 75.4%, respectively) and mid-esophagus tumor (43.2% and 37.7% respectively) than the non-Hispanic white and Hispanic white groups. The incidences of ESCC in all ethnic groups declined since 1973, especially in black males. At the same time, incidences of esophageal adenocarcinoma (EAC) dramatically increased in white males since 1973. And incidences of ESCC and EAC were the lowest and stable in Asian female. Multivariable models showed that patients who were male, or black, or had larger tumors, or positive lymph nodes had an increased risk of death from esophageal cancer, while patients with ESCC or diagnosed after 2005 or treated with surgery had a lower likelihood of death. For ESCC, the black patients had the lowest DSS, while for EAC there were no significant differences in DSS among the ethnic/racial groups.Materials and MethodFrom the Surveillance, Epidemiology, and End Results Program database, patients diagnosed with esophageal cancer from 1998-2013 were identified. Differences in incidences, clinicopathological features, treatments, and disease-specific survival (DSS) in four broad racial/ethnic groups were compared.ConclusionHistological type distribution between racial groups could be an important consideration in the incidence and the survival trend but other factors could also have an effect.
Highlights
Esophageal cancer was the eighth most common cancer and the sixth most common cause of cancer-related death worldwide; 456,000 new cases and 400,000 deaths were estimated for 2012 [1]
Histological type distribution between racial groups could be an important consideration in the incidence and the survival trend but other factors could have an effect
Black patients were younger at diagnosis(median age, 63years) than non-Hispanic white (NHW) and Asian patients
Summary
Esophageal cancer was the eighth most common cancer and the sixth most common cause of cancer-related death worldwide; 456,000 new cases and 400,000 deaths were estimated for 2012 [1]. Previous studies have shown ethnic differences in incidence rate, mortality rate, and disease characteristics of esophageal cancer [3,4,5]. Black (African Americans) patients had higher rates of esophageal squamous cell cancer (ESCC), while whites had higher rates of esophageal adenocarcinoma (EAC) [6]; the uneven distribution of histological cancer types between racial groups resulted in ethnic/racial differences in the disease incidence and outcomes. The 5-year overall survival rate for EAC increased from 5% to 20%since the late 1970s and has exceeded that of ESCC [8] Other factors such as tobacco use, alcohol consumption, diet, and methods of treatment affected the incidence percentages and survival durations among racial groups [9,10,11]. Among esophageal cancer patients in California, Asian-Americans showed different clinical characteristics than those of the NHW group, with lower percentages of EAC and higher percentages of ESCC [8]
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