Higher clinical suspicion is needed for prompt diagnosis of esophageal adenocarcinoma in young patients Journal Article


Authors: Nobel, T. B.; Curry, M.; Gennarelli, R.; Jones, D. R.; Molena, D.
Article Title: Higher clinical suspicion is needed for prompt diagnosis of esophageal adenocarcinoma in young patients
Abstract: Background: Esophageal cancer is considered a disease of the elderly. Although the incidence of esophageal adenocarcinoma in young patients is increasing, current guidelines for endoscopic evaluation of gastroesophageal reflux disease and Barrett's esophagus include age as a cutoff. There is a paucity of data on the presentation and treatment of esophageal cancer in young patients. Most studies are limited by small sample sizes, and conflicting findings are reported regarding delayed diagnosis and survival compared with older patients. Methods: A retrospective cohort study was performed using the National Cancer Database between 2004 and 2015. Patients with esophageal adenocarcinoma were divided into quartiles by age (18-57, 58-65, 66-74, 75+ years) for comparison. Clinicopathologic and treatment factors were compared between groups. Results: A total of 101,596 patients were identified with esophageal cancer. The youngest patient group (18-57 years) had the highest rate of metastatic disease (34%). No difference in tumor differentiation was observed between age groups. Younger patient groups were more likely to undergo treatment despite advanced stage at diagnosis. Overall 5-year survival was better for younger patients with local disease, but the difference was less pronounced in locoregional and metastatic cases. Conclusions: In this study, young patients were more likely to have metastatic disease at diagnosis. Advanced stage in young patients may reflect the need for more aggressive clinical evaluation in high-risk young patients. © 2019 The American Association for Thoracic Surgery
Keywords: adult; cancer survival; controlled study; aged; cancer surgery; major clinical study; overall survival; advanced cancer; multimodality cancer therapy; comparative study; disease free survival; cancer staging; antineoplastic agent; cancer diagnosis; metastasis; cohort analysis; practice guideline; retrospective study; groups by age; adjuvant chemotherapy; delayed diagnosis; esophagus cancer; esophageal adenocarcinoma; young patients; chemoradiotherapy; esophageal cancer; screening guidelines; human; male; female; priority journal; article
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 159
Issue: 1
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2020-01-01
Start Page: 317
End Page: 326.e5
Language: English
DOI: 10.1016/j.jtcvs.2019.03.095
PUBMED: 31126651
PROVIDER: scopus
PMCID: PMC6801049
DOI/URL:
Notes: Article -- Export Date: 3 February 2020 -- Source: Scopus
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MSK Authors
  1. David Randolph Jones
    212 Jones
  2. Daniela   Molena
    89 Molena
  3. Tamar B Nobel
    24 Nobel
  4. Michael A Curry
    7 Curry