OGC P41 Presentation, Management and Outcomes in Young Patients Diagnosed with Oesophageal Cancer

Abstract

Abstract Background Oesophageal cancer is a devastating malignancy associated with poor prognosis, primarily affecting older individuals with multiple co-morbidities. However, outcomes of younger patients have been perceived as poor due to late diagnosis and more aggressive disease subtype. This subset of patients poses unique clinical challenges and requires a better understanding of their outcomes. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with oesophageal cancer, to provide further insights into this understudied population. Methods A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger at the time of diagnosis of oesophageal cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following oesophagectomy were compared to publicly available outcomes. Results 87/2485 (3.5%) of patients studied were aged 50 or below at the time of diagnosis. Mean age at diagnosis was 44.3 (range = 24-50); 71% were male. Adenocarcinoma and SCC accounted for 73% (33% poorly differentiated, 40% moderately differentiated) and 25% of cases respectively. The majority presented with c-stage III (24%), c-stage IVa (17%) and c-stage IVb (46%) disease. Initial treatment intent was curative in 43%. 1-and 3-year overall survival rates were 49% and 21% respectively - similar to the wider population. 1- and 3-year survival rates after oesophagectomy were 80% and 44.5% (versus 82.5% and 59.5% for wider population). Conclusions Our findings underscore the concerns about the proportion of advanced-stage diagnosis in young patients with oesophageal cancer, and poorer longer-term outcomes after curative resection. This highlights the importance of timely detection and appropriate treatment strategies in this patient group. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies as well as validating these finding in larger and more diverse patient populations.