The impact of young age on outcomes in esophageal and junctional cancer.

It is not known whether patients diagnosed with esophageal and junctional cancer aged younger than 50 years have a more aggressive disease phenotype and thus poorer outcomes following treatment. Prospectively maintained database records of all patients diagnosed with esophageal carcinoma (n= 2129) over a 20-year period (1990-2009) in a single institution were analyzed. Patients aged less than 50 years at diagnosis (n= 170) were compared with those over 50 years with respect to clinicopathological stage and oncological outcomes. There was a significantly greater proportion of male patients (77.4 vs. 64.7%) among the younger group (P= 0.001). Patients were more likely to be diagnosed with an esophagogastric junction tumor (P= 0.002) and to have symptoms for a longer period prior to diagnosis (24.0 vs. 17.8 weeks, P= 0.03) if they were aged less than 50 years old. There was no significant difference in clinicopathological staging including Tumor-Nodal-Metastasis (TNM) stage, differentiation, and lymphatic and perineural invasion other than a greater likelihood of venous invasion in the older group (P= 0.002). Younger patients were more likely to be treated with curative rather than palliative intent (66.9 vs. 51.1%, P < 0.001). The disease-specific survival of patients younger than 50 years treated with curative intent was significantly greater than older patients (median 35 vs. 21 months, P= 0.04), except for the subgroup of patients aged less than 35 years (n= 18) who have reduced survival. Multivariate analysis revealed independent factors related to the difference in survival included sex, age, advanced T stage, and nodal metastases (P < 0.05). A consistent proportion of esophageal cancer patients are diagnosed aged less than 50 years old over time (1990-2009). Few phenotypic tumor differences were noted between the groups. With an aggressive approach to management, survival is significantly greater than in the older cohort, although outcomes are poorer in those aged below 35 years.