Interaction between histology and staging on survival outcomes of patients diagnosed with esophageal cancer over the past decade.
Authors: Bangolo Ayrton , Fwelo Pierre , Dey Shraboni , Chacko Angel Ann , Aguilar Izage Kianifar , Tran Hadrian , Periel Luis , Levy Charlotte , Menon Aiswarya , Nagesh Vignesh , Wadhwani Nikita , Furman Flor , Elias Daniel , Mansour Charlene , Weissman Simcha 
Published: July 2024

e16054

Background: Esophageal cancer (EC) ranks sixth globally in cancer-related deaths , continuing to be a significant public health concern . The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Methods: A total of 22,979 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage and histologic subtypes were analyzed and associated mortality was measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or < 0.01 were incorporated into a multivariate Cox proportional hazards model. The primary outcome of this study was discernment of clinicopathologic variables associated with mortality, with a primary focus on delineation of the association between the latter, and tumor stage and histologic subtype respectively. A hazard ratio > 1 was indicative of increased risk for mortality in presence of the variable under discussion. Results: 22,979 patients: Male (79.78%), age 60-79 (59.78%), non-Hispanic whites (77.44%). Distant metastases in 41.27%, adenocarcinoma prevalent (66.72%). Crude analysis revealed higher EC-related mortality in males (HR: 1.06, 95% CI: 1.02-1.11), non-Hispanic blacks (HR: 1.32, 95% CI: 1.25-1.39), and Hispanics (HR: 1.12, 95% CI: 1.05-1.18). Multivariate analyses showed higher overall mortality in males (HR = 1.13, 95% CI 1.08-1.18, p < 0.01), distant tumor stage (HR = 2.93, 95% CI 1.56-5.52, p < 0.01), and advanced age. Stand-alone surgical therapy (HR = 0.29, 95% CI 0.28-0.31, p < 0.01) and adenocarcinoma histology (HR = 0.49, 95% CI 0.27-0.89, p < 0.01) correlated with lower mortality. Notable interaction: Gastrointestinal Stromal Tumor (GIST) histology, especially with local structure invasion, increased overall mortality (HR = 7.25, 95% CI 1.17-45.11, p < 0.05) and GIST-related mortality (HR = 46.09, 95% CI 3.42-620.37, p < 0.01). Conclusions: Adenocarcinoma histology and distant metastases at diagnosis elevate all-cause and EC-associated mortality in EC patients. Demographics matter; males, non-Hispanic blacks, and advanced age associate with increased mortality. GIST histology, particularly with local invasion, significantly raises mortality. Further research can unravel histopathology and staging's impact on overall and cancer-specific mortality, aiding targeted therapy. This study aims to assist physicians in identifying at-risk populations and encourages more research to address racial disparities, ultimately enhancing aggressive therapies and improving mortality outcome.