Division of Oncology, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA.
Ann Surg Oncol. 2012 May;19(5):1685-91. doi: 10.1245/s10434-011-2141-1. Epub 2011 Dec 1.
Our aim was to evaluate the changes in age, stage distribution, and overall survival (OS) of patients with esophageal adenocarcinoma (EAC) over time.
Patients from the Surveillance, Epidemiology, and End Results (SEER) database aged ≥ 20 with invasive EAC, diagnosed from 1973-2003 were reviewed. Survival follow-up ended in 2006.
There were 11,620 patients; 6580 (57%) aged ≥ 65. The stage distribution was 22%, 35%, and 43% for localized, regional, and distant metastasis for patients aged <65, and 33%, 33%, and 34% for patients aged ≥ 65. The number of patients ≥ 65 years with localized stage increased over time. Three-year OS for localized, regional, and distant disease increased from 19%, 10%, and 1% in 1973-1976, to 34%, 13%, and 2% in 1987-1991, and to 45%, 25%, and 4% in 2002-2003 (P < 0.001). A sub-analysis of 5475 patients from 1988-2002 showed better survival for patients with esophagectomy for all stages. Three-year OS for 2074 patients with esophagectomy improved every 5 years from 1988-2002 (39%, 43% to 54%, P < 0.001). Stratified by stage, year and esophagectomy status, patients aged <65 had better survival compared to patients aged ≥ 65 (P < 0.001).
There has been a substantial improvement in overall survival among patients with invasive EAC over the last 3 decades. Patients receiving esophagectomy had longer survival. Survival with esophagectomy improved in each time period. Although younger EAC patients were diagnosed at more advanced stages over time, they had better survival.
本研究旨在评估食管腺癌（EAC）患者的年龄、分期分布和总生存期（OS）随时间的变化。
回顾了 1973 年至 2003 年间年龄≥20 岁、经组织学证实为浸润性 EAC 且来自监测、流行病学和最终结果（SEER）数据库的患者。生存随访截止至 2006 年。
共纳入 11620 例患者，其中 6580 例（57%）年龄≥65 岁。对于年龄<65 岁的患者，局部、区域和远处转移的分期分布分别为 22%、35%和 43%，而年龄≥65 岁的患者的分期分布分别为 33%、33%和 34%。随着时间的推移，≥65 岁且处于局部阶段的患者数量增加。1973-1976 年、1987-1991 年和 2002-2003 年，局部、区域和远处疾病的 3 年 OS 分别为 19%、10%和 1%、34%、13%和 2%以及 45%、25%和 4%（P<0.001）。1988-2002 年 5475 例患者的亚组分析显示，所有分期的患者接受食管切除术的生存情况更好。1988-2002 年，每 5 年接受食管切除术的 2074 例患者的 3 年 OS 均有所提高（39%、43%至 54%，P<0.001）。按分期、年份和食管切除术状态分层，<65 岁的患者比≥65 岁的患者的生存情况更好（P<0.001）。
在过去的 30 年中，侵袭性 EAC 患者的总体生存率有了显著提高。接受食管切除术的患者生存时间更长。每个时间段食管切除术的生存获益都在增加。尽管年轻的 EAC 患者随着时间的推移被诊断为更晚期，但他们的生存情况更好。
