Predictors of survival among patients diagnosed with adenocarcinoma of the esophagus and gastroesophageal junction

Abstract

Purpose: Patients diagnosed with esophageal adenocarcinoma (EAC) or gastroesophageal junction adenocarcinoma (GEJAC) have poor survival. We investigated the possible influence of pre-morbid lifestyle factors on survival for these lethal cancers.

Methods: This study included a population-based cohort of patients with EAC (n = 362) and GEJAC (n = 421) tumors. Detailed information about demographic and lifestyle factors was obtained around the time of diagnosis, and deaths were identified using the National Death Index. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated from Cox proportional hazards models, adjusted for age, sex, pre-treatment American Joint Committee on Cancer tumor stage, treatment and presence of comorbidities.

Results: Median follow-up for mortality was 6.4 years. Five-year survival rates were 27 and 33% for EAC and GEJAC, respectively. As expected, tumor and treatment characteristics were the strongest predictors of survival for both cancer sites. Among patients diagnosed with GEJAC tumors, those who were older (≥ 70 years, adjusted HR = 1.70, 95% CI 1.24-2.32) and those who reported being current smokers (adjusted HR = 1.45, 95% CI 1.02-2.06) fared worse. Other lifestyle factors putatively associated with risk of developing GEJAC including body mass index, gastroesophageal reflux symptoms, alcohol, and use of non-steroidal anti-inflammatory drugs were not associated with survival. Likewise, after adjusting for stage and treatment, no clear associations were detected between lifestyle factors and survival among patients with EAC tumors. We found similar results for analyses restricted to patients treated surgically.

Conclusions: Overall, our data suggest that lifestyle factors do not appear to unduly influence survival for these cancers.