Abstract 1903: Esophageal cancer clinical and socioeconomic aspects in Brazil: Inequalities affect patients from diagnosis to prognosis
Authors: Reisner Rachele Grazziotin , de Carvalho Flávia Nascimento , Pinto Luis Felipe Ribeiro , Soares-Lima Sheila Coelho 
Published: April 2023

Abstract
Esophageal cancer is the sixth most incident and the fifth most lethal cancer among men in Brazil. Advanced stages at presentation, unsatisfactory therapeutic results, as well as high recurrence and mortality rates reflect the disease limited knowledge and highlights the need for new strategies aiming at better patient care. In this study, we evaluated a retrospective cohort of 850 esophageal cancer cases enrolled at the Brazilian National Cancer Institute (INCA) from 2012 to 2016. Patients’ sociodemographic and clinical characteristics were compared between the most frequent histological types (adenocarcinoma - EAC and squamous cell carcinoma - ESCC), and variables associated with advanced presentation at diagnosis, offering curative treatments, response to therapy and overall survival (OS) were evaluated. Relative to EAC, patients with ESCC were younger (p=0.007); more frequently non-white (p&lt;0.001); most often did not have a partner (p&lt;0.001); showed lower education levels (p&lt;0.001); and were more frequently smokers and drinkers (p&lt;0.001). The frequency of patients not receiving any treatment was higher among ESCC (40.8%) relative to EAC (32.6%) (p=0.003). Furthermore, potentially curative treatments (surgery or trimodal treatment) were more commonly offered to EAC patients (p&lt;0.001). ESCC patients showed a median OS of 7.4 months (6.7 - 8.0 months) relative to 10.3 months (8.4 - 12.1 months) among EAC patients (p &lt;0.001). When analyzing specific histologic tumor types, variables associated with EAC stages I and II were female sex (p=0.016); non-metropolitan origin; and non-alcoholic (p=0.048). Also, in EAC, higher education levels (p&lt;0.001) were associated with curative treatments. EAC OS was significantly and independently associated with tumor stage at diagnosis (p=0.001) and curative treatments (p&lt;0.001). In ESCC, early diagnosis was associated with white skin color (p=0.031) and occurrence of second primary tumors (p&lt;0.001). Curative treatments were more commonly offered to ESCC patients who had a partner (p=0.028); higher education levels (p=0.010); and who were non-drinkers (p=0.042). Chemoradiotherapy resistance was associated with smoking (p=0.001) and low body mass index (p=0.028) among ESCC cases, while OS was significantly and independently associated with smoking (p=0.002) and staging (p&lt;0.001). In summary, sociodemographic and clinical characteristics affected outcomes and special attention should be given to modifiable risk factors such as smoking and nutritional status. In addition, our study evidenced how social aspects are inextricably linked to health outcomes, and efforts should be made to minimize this gap.
Citation Format: Rachele Grazziotin Reisner, Flávia Nascimento de Carvalho, Luis Felipe Ribeiro Pinto, Sheila Coelho Soares-Lima. Esophageal cancer clinical and socioeconomic aspects in Brazil: Inequalities affect patients from diagnosis to prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1903.