Zeng Yuan, Ruan Wenli, Liu Jun, Liang Wenhua, He Jiaxi, Cui Fei, Pan Hui, He Jianxing
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.
J Thorac Dis. 2018 May;10(5):2542-2550. doi: 10.21037/jtd.2018.05.72.
Concomitant with rising rates of esophageal adenocarcinoma, there has been a significant increase of diagnoses among relatively younger individuals. However, most studies that focus on esophageal cancer (EC) in younger patients have had small sample sizes of patients treated at a single institute. The aim of this study was to analyze the clinical characteristics, outcomes and independent prognostic factors for EC in patients under 50-year-old using a large, multi-center dataset.
The national Surveillance, Epidemiology, and End Results (SEER) database was analyzed for EC reported from 2004 to 2013. Patients were divided into two groups, those under 50-year-old and those 50 years or older, and comparisons were made regarding demographics, histology, stage distribution, treatment, overall survival (OS), and esophageal cancer-specific survival (ECSS). Multivariate Cox proportional hazard regression analyses were also used to identify independent prognostic factors.
Among the 16,544 eligible patients, 1,385 (8.37%) were under 50 and 15,159 (91.63%) were over 50. Compared with the older group, patients under 50 were characterized by a higher frequency of males, lower esophagus involvement, adenocarcinoma histology, stage III/IV disease, and receiving esophagectomy or radiation therapy. The stage-wise OS and ECSS were significantly better in the younger group (P<0.001). The multivariate analysis indicated that African-American heritage, grade III or IV, later stage, and not undergoing surgical or radiation therapy were independent negative prognostic factors of ECSS for patients under 50.
EC patients under 50-year-old had distinctive clinicopathological characteristics compared with patients over 50-year-old. Despite more often presenting with stage III and IV disease, survival rates were better in the younger cohort. Prognostic factors for ECSS in patients under 50 differed from those in all age patients.
随着食管腺癌发病率的上升，相对年轻个体中的诊断病例显著增加。然而，大多数关注年轻患者食管癌（EC）的研究样本量较小，且患者来自单一机构。本研究的目的是使用大型多中心数据集分析50岁以下EC患者的临床特征、预后及独立预后因素。
分析2004年至2013年国家监测、流行病学和最终结果（SEER）数据库中报告的EC病例。患者分为两组，50岁以下组和50岁及以上组，比较两组的人口统计学、组织学、分期分布、治疗、总生存期（OS）和食管癌特异性生存期（ECSS）。还采用多变量Cox比例风险回归分析来确定独立预后因素。
在16544例符合条件的患者中，1385例（8.37%）年龄在50岁以下，15159例（91.63%）年龄在50岁及以上。与老年组相比，50岁以下患者的特点是男性比例较高、食管下段受累较少、腺癌组织学类型、III/IV期疾病以及接受食管切除术或放射治疗。年轻组的各分期OS和ECSS明显更好（P<0.001）。多变量分析表明，非裔美国人血统、III或IV级、晚期以及未接受手术或放射治疗是50岁以下患者ECSS的独立不良预后因素。
与50岁以上患者相比，50岁以下的EC患者具有独特的临床病理特征。尽管50岁以下患者III期和IV期疾病更为常见，但年轻队列的生存率更高。50岁以下患者ECSS的预后因素与所有年龄患者不同。
