Young Adults With Esophageal Adenocarcinoma Present With More Advanced Stage Tumors and Have Shorter Survival Times.

BACKGROUND & AIMS: Obesity is increasing in younger populations. Barrett's esophagus is associated with central obesity, so we investigated the occurrence of esophageal adenocarcinoma (EAC) in younger patients and compared them with older patients to determine differences in features at presentation and survival times.

METHODS

We performed a single-center, retrospective study of 682 patients with a diagnosis of EAC treated from 2009 through 2012. We used a Cox proportional hazards model to compare survival times among young (less than 50 years, n = 105), middle age (51-70 years, n = 383), and older age (more than 70 years, n = 194) patients. We collected data on demographic features of patients and information from medical records. Baseline characteristics were compared using χ2 analysis for categorical variables and analysis of variance for continuous variables.

RESULTS

Higher proportions of patients in the young group presented with stage III EAC (43.8%) or stage IV EAC (33.3%), compared to the middle age group (39.7% with stage III and 21.7% with stage IV; P < .001) and older group (30.4% with stage III and 20.6% with stage IV; P < .001). The mean time of survival after diagnosis in the young group was 4 ± 4.2 years, compared to 5 ± 3.9 years in the middle age group (P = .03). The unadjusted model demonstrated an increased risk of death in the young group compared to the middle age group (hazard ratio, 1.5; 95% CI, 1.1-1.9; P = .004). Controlling for confounders such as sex, comorbidity index, stage, and the presence of intestinal metaplasia resulted in an adjusted hazard ratio of 1.34 for the young group (95% CI, 1.02-1.75; P = Intestinal metaplasia was detected in a higher proportion of patients in the middle age group (51.7%) than the young group (37.1%) (P < .001).

CONCLUSION

In a retrospective analysis of patients with EAC treated at a single center, we found that a higher proportion of young patients (younger than 50 years) present advanced-stage tumors than middle age patients; young patients also have shorter survival times than middle age patients with EAC. Studies are needed to determine whether this difference is due to a lack of symptoms or endoscopic screening or distinct mechanisms of more aggressive tumors.