DETERMINANTS OF SURVIVAL FOLLOWING THE DIAGNOSIS OF ESOPHAGEAL ADENOCARCINOMA (UNITED-STATES)

The rapidly rising incidence of esophageal adenocarcinomas in the Unit ed States and western Europe remains unexplained. Most persons who dev elop the disease have had long-standing gastroesophageal reflux sympto ms with concomitant Barrett's metaplasia. They are, therefore, potenti ally identifiable for endoscopic screening and cancer surveillance, wh ich should facilitate the early detection of these tumors. We undertoo k these analyses to determine the extent to which the opportunity for early diagnosis and treatment of esophageal adenocarcinomas has been r ealized in the US. Specifically, using data from the Surveillance, Epi demiology, and End Results (SEER) program of the US National Cancer In stitute, we examined changes in stage of disease at diagnosis and in s urvival between 1973 and 1991 and investigated patient characteristics as predictors of survival. Improvements in stage at diagnosis and in survival between 1973 and 1991 were minor and clinically insignificant ; overall five-year survival never exceeded 10 percent. Stage of disea se at diagnosis was the strongest determinant of subsequent survival; five-year survival with patients with in situ tumors was 68.2 percent. This survival advantage persisted up to 15 years after diagnosis and was independent of other prognostic factors. We conclude that the oppo rtunity for reduction in esophageal cancer mortality has been largely unrealized in the US. In light of the increasing incidence of esophage al adenocarcinoma, efforts should be devoted to identifying those at h ighest risk of developing Barrett's metaplasia and subsequent adenocar cinoma, and to developing cost-effective primary prevention and cancer surveillance methods targetting them.