青年发病型食管腺癌的流行病学和结局：基于人群数据库的分析。
Epidemiology and Outcomes of Young-Onset Esophageal Adenocarcinoma: An Analysis from a Population-Based Database.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
出版信息
Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):142-149. doi: 10.1158/1055-9965.EPI-20-0944. Epub 2020 Dec 11.
BACKGROUND
Esophageal adenocarcinoma is a lethal cancer with rising incidence. There are limited data in younger (<50 years) patients with esophageal adenocarcinoma. We aimed to assess time trends in the incidence and outcomes of "young-onset" esophageal adenocarcinoma using a population-based database.
METHODS
We queried the Surveillance, Epidemiology, and End Results 9 database to identify patients with esophageal adenocarcinoma between 1975 and 2015. Patients were stratified into three age strata: <50, 50 to 69, and ≥70 years. Staging was stratified as localized, regional, and distant. Trends in incidence, disease stage, and survival were assessed in three periods (1975-89, 1990-99, and 2000-2015). Univariate and multivariate models were created to identify predictors of mortality.
RESULTS
Esophageal adenocarcinoma incidence has increased in patients <50 years of age, with an annual percentage change of 2.9% (95% confidence interval, 1.4%-4.4%) from 1975 to 2015. Young-onset esophageal adenocarcinoma presented at more advanced stages (regional + distant) compared with older patients (84.9% vs. 67.3%; < 0.01), with increasing proportion of advanced stages over the study period. These patients also experienced poorer 5-year esophageal adenocarcinoma-free survival compared with older patients (22.9%% vs. 29.6%; < 0.01), although this finding was attenuated on stage-stratified analysis.
CONCLUSIONS
Young-onset esophageal adenocarcinoma, while uncommon, is rising in incidence. Concerningly, the proportion of advanced disease continues to increase. Young-onset esophageal adenocarcinoma also presents at more advanced stages, resulting in poorer esophageal adenocarcinoma-free survival.
IMPACT
Patients with esophageal adenocarcinoma younger than 50 years present at more advanced stages with higher esophageal adenocarcinoma-specific mortality compared with older peers. Current diagnostic and management strategies for young-onset esophageal adenocarcinoma may need to be reevaluated.
背景
食管腺癌是一种致命的癌症，发病率不断上升。在年龄较轻（<50 岁）的食管腺癌患者中，相关数据有限。本研究旨在利用基于人群的数据库评估“早发性”食管腺癌发病率和结局的时间趋势。
方法
我们查询了 Surveillance, Epidemiology, and End Results 9 数据库，以确定 1975 年至 2015 年间患有食管腺癌的患者。患者分为 3 个年龄组：<50 岁、50-69 岁和≥70 岁。分期分为局限性、区域性和远处转移。评估了三个时期（1975-89 年、1990-99 年和 2000-2015 年）的发病率、疾病分期和生存趋势。建立了单变量和多变量模型，以确定死亡率的预测因素。
结果
年龄<50 岁的食管腺癌患者的发病率有所增加，1975 年至 2015 年的年变化百分比为 2.9%（95%置信区间，1.4%-4.4%）。早发性食管腺癌与老年患者相比，处于更晚期（局部+远处）（84.9%比 67.3%；<0.01），并且在研究期间，晚期的比例不断增加。这些患者与老年患者相比，5 年食管腺癌无病生存率较差（22.9%比 29.6%；<0.01），但在分期分层分析中，这一发现有所减弱。
结论
虽然少见，但早发性食管腺癌的发病率正在上升。令人担忧的是，晚期疾病的比例继续增加。早发性食管腺癌也处于更晚期，导致食管腺癌无病生存率较差。
影响
年龄<50 岁的食管腺癌患者与年龄较大的患者相比，处于更晚期，食管腺癌特异性死亡率更高。目前针对早发性食管腺癌的诊断和治疗策略可能需要重新评估。
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