Abstract
BackgroundEsophageal adenocarcinoma (EAC) is the most common kind of esophageal cancer. Age at diagnosis of advanced EAC is greater. Studies about practice patterns for elderly EAC patients with distant metastasis (DM) in stage IVB are limited. This retrospective, population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) to evaluate 855 elderly EAC patients with DM in stage IVB from 2010 to 2015.Methods855 elderly EAC patients with DM in stage IVB between 2010 and 2015 were included in this study. Univariate and multivariate Cox-regression and Kaplan-Meier analyses were used to assess prognosis. These patients were classified to bone-only, brain-only, lung-only, liver-only, and multiple (patients with two or more organs in metastasis)-site group according to the site of metastasis. Overall survival (OS), cancer-specific survival (CSS), median survival time (MST), and survival rate (SR) were evaluated to analyze the survival outcomes.ResultsThe most common metastasis site was the liver among the single-organ metastasis population, followed by lung, bone, and brain. Compared with the bone-only group, the multiple-site group was associated with worst OS (HR: 1.037, 95% CI: 0.811–1.327, p = 0.770) and CSS (HR: 1.052, 95% CI: 0.816–1.357, p = 0.695). The multiple-site group also had the lowest MST in the population (MST: 2 months in OS and 3 months in CSS) and SR (6-month SR: 27.1% in OS, 29.9% in CSS, 1-year SR: 10.7% in OS, 12.0% in CSS, 3-year SR: 2.5% in OS, 2.8% in CSS). Compared to untreated patients (N) in the total population, other patients who were treated with surgery (S), radiotherapy (R), and chemotherapy (C) are beneficial for the prognosis (OS and CSS: p < 0.001).ConclusionThis population-based study was conducted to ascertain metastasis patterns and survival outcomes of EAC patients with DM in stage IVB. Elderly patients with multiple-site metastasis exhibited the worst OS and CSS among all the populations, and patients with bone-only metastasis had the worst OS and CSS among single-organ metastasis populations. Active treatment is beneficial for elderly EAC patients with DM in stage IVB, especially chemotherapy. This study also shows that more than one third of the patients had not received any therapy.
Highlights
Esophageal cancer (EC) is the seventh leading cause of cancerrelated mortality in America, the sixth leading cause of cancerrelated mortality worldwide, and its incidence continues to increase [1, 2]
According to the eligibility criteria, 855 elderly Esophageal adenocarcinoma (EAC) patients with distant metastasis (DM) in stage IVB diagnosed between 2010 and 2015 were included, as the SEER database did not record the information about sitespecific metastasis before 2010
The group with multiple metastatic sites had 269 (31.5%) patients. 793 (92.7%) patients had the original tumor located in the lower third of the esophagus. 246 (28.8%) patients had chemotherapy alone, followed by surgery (S) and/or radiotherapy (R) + chemotherapy (C) 189 (22.1%) and surgery and/or radiotherapy 113 (13.2%)
Summary
Esophageal cancer (EC) is the seventh leading cause of cancerrelated mortality in America, the sixth leading cause of cancerrelated mortality worldwide, and its incidence continues to increase [1, 2]. According to the incidence data of EC extracted from 12 countries, the number of EAC cases is expected to increase rapidly from 2005 to 2030, while the incidence of esophageal squamous cell carcinoma (ESCC) will continue to decline [3]. Studies about practice patterns for elderly EAC patients with distant metastasis (DM) in stage IVB are limited. This retrospective, population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) to evaluate 855 elderly EAC patients with DM in stage IVB from 2010 to 2015
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