Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
J Gastroenterol Hepatol. 2024 Jun;39(6):1073-1081. doi: 10.1111/jgh.16514. Epub 2024 Feb 14.
The prognosis of early-onset adenocarcinoma of esophagogastric junction (AEG) remains unclear. This research aimed at comparing the prognosis between early-onset and late-onset AEGs.
We extracted eligible patients with surgically resected, pathologically confirmed, nonmetastatic AEG from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. The cutoff age of early-onset AEG was set at ≤50 years old. Univariate and multivariate Cox analysis as well as competing risk model were adopted for comparing overall survival (OS) and cancer-specific survival (CSS) between early-onset and late-onset AEGs. In addition, multiple imputation and propensity score matching (PSM) were also carried out for sensitivity analysis.
In total, 4610 eligible AEG patients were collected in this study, including 610 early-onset AEGs and 4000 late-onset AEGs. Kaplan-Meier curves revealed significantly better survival in early-onset AEGs than late-onset AEGs. After interpolating missing data by multiple imputation, multivariate Cox regression analysis similarly showed better OS and CSS in early-onset AEGs. By using PSM analysis at a ratio of 1:1, we matched 610 early-onset AEG patients with 610 late-onset AEG patients. After PSM, univariate Cox regression model still revealed favorable prognosis in early-onset AEGs. Similar results were confirmed by performing PSM analysis at a ratio of 1:2 and 1:3. In addition, competing risk model demonstrated significantly lower cancer-specific death in early-onset AEGs compared to late-onset AEGs before and after matching.
By applying several effective sensitivity analyses, we reported significantly favorable OS and CSS in early-onset AEGs compared to late-onset AEGs.
食管胃结合部早发型腺癌（AEG）的预后仍不清楚。本研究旨在比较早发型和晚发型 AEG 的预后。
我们从 2004 年至 2015 年的监测、流行病学和最终结果数据库中提取了手术切除、病理证实、非转移性 AEG 的合格患者。早发型 AEG 的截定点年龄设定为≤50 岁。采用单因素和多因素 Cox 分析以及竞争风险模型比较早发型和晚发型 AEG 的总生存期（OS）和癌症特异性生存期（CSS）。此外，还进行了多重插补和倾向评分匹配（PSM）进行敏感性分析。
本研究共纳入 4610 例符合条件的 AEG 患者，其中早发型 AEG 610 例，晚发型 AEG 4000 例。Kaplan-Meier 曲线显示早发型 AEG 的生存明显优于晚发型 AEG。通过多重插补法插补缺失数据后，多因素 Cox 回归分析同样显示早发型 AEG 的 OS 和 CSS 更好。通过 1:1 的 PSM 分析，我们匹配了 610 例早发型 AEG 患者和 610 例晚发型 AEG 患者。PSM 后，单因素 Cox 回归模型仍显示早发型 AEG 的预后较好。在进行 1:2 和 1:3 的 PSM 分析后，也得到了相似的结果。此外，竞争风险模型表明，匹配前后早发型 AEG 的癌症特异性死亡明显低于晚发型 AEG。
通过应用几种有效的敏感性分析，我们报告了早发型 AEG 的 OS 和 CSS 明显优于晚发型 AEG。
