Trends in the incidence and survival of patients with esophageal cancer: A SEER database analysis

Abstract

Background: Recent studies have indicated that the incidence of esophageal cancer has declined in the past decade in the U.S. However, trends in the incidence and survival have not been thoroughly examined.

Methods: Data from 46 063 patients with esophageal cancer between 1973 and 2015 were collected from the Surveillance, Epidemiology, and End Results database. The trends in the age-adjusted incidence and survival were analyzed using joinpoint regression models.

Results: The age-adjusted incidence of esophageal cancer increased from 5.55 to 7.44 per 100 000 person-years between 1973 and 2004. Later, it decreased at an annual percentage change of 1.23%. In the last 40 years, the strong male predominance increased slightly. Importantly, the percentage of patients with localized stage of squamous cell cancer decreased. It was observed that the incidence of esophageal squamous cell carcinoma declined since 1986, while the incidence of esophageal adenocarcinoma sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. Consistently, the estimated 40-year limited-duration prevalence of esophageal adenocarcinoma was higher than that of esophageal squamous cell carcinoma. Additionally, we observed a modest but significant improvement in survival during the study period.

Conclusion: The incidence of esophageal squamous cell carcinoma has decreased significantly over the past four decades in the U.S., while the incidence of adenocarcinoma has increased, particularly among men. Overall, the long-term survival of patients with esophageal cancer is poor but it has improved over the past decades, especially for the localized disease.

Key points: Significant findings of the study The incidence of esophageal cancer has decreased at an annual percentage change of 1.23% since 2004. The incidence of esophageal adenocarcinoma has sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. What this study adds There has been a shift in the prevalence of esophageal cancer histological subtypes over the past decades in the U.S. We found that the incidence of esophageal squamous cell carcinoma has continued to decrease, while the esophageal adenocarcinoma rate has continued to increase.

Keywords: SEER; esophageal cancer; incidence; prevalence; survival.

Figure 1

Joinpoint analysis of the incidence rates of esophageal cancer in the U.S. between 1973 and 2015. (^) Indicates the annual percent change (APC) that is significantly different from zero (P < 0.05). observed, 1973–2004 APC = 0.56^, 2004–2015 APC = −1.23^.

Figure 2

Incidence trends of esophageal cancer stratified by sex in the U.S. (1973–2015). (a) The male‐to‐female ratio of patients with esophageal cancer was calculated from the absolute count of male and female patients. (b) Joinpoint analysis of the incidence rates of esophageal cancer stratified by sex. Male – 1 Joinpoint, 1973–2004 APC = 0.77^, 2004–2015 APC = −1.24^. Female –_Joinpoint, 1973–1996 APC = −0.04^, 1996–2015 APC = −1.24^. (^) Indicates the annual percent change (APC) that is significantly different from zero (P < 0.05).

Figure 3

Annual percent change (APC) in age‐specific esophageal cancer incidence rates in the U.S. (1973–2015). An asterisk indicates the APC that is significantly different from zero (P < 0.05).

Figure 4

The SEER stage distribution of esophageal cancer cases diagnosed in the U.S. (1973–2015). The percentage of patients represented by localized, regional, distant, and unstaged subtypes were calculated for patients with (a) esophageal cancer, Localized, regional, distant, unstaged. (b) esophageal squamous cell carcinoma, Localized, regional, distant, unstaged. and (c) esophageal adenocarcinoma. Localized, regional, distant, unstaged.

Figure 5

Joinpoint analysis of the incidence rates of esophageal cancer stratified by the histological type in the U.S. (1973–2015). (^) Indicates the annual percent change (APC) that is significantly different from zero (P < 0.05). Squamous – 1 Joinpoint, 1973–1985 APC = 0.30, 1985–2015 APC = −3.08^; Adenocarcinoma – 1 Joinpoint, 1973–1999 APC = 7.82^, 1999–2015 APC = 0.58^; other – 2 joinpoints, 1973–1983 APC = −4.80^, 1983–2009 APC = −0.19, 2009–2015 APC = −6.30^.

Figure 6

Joinpoint analysis of the incidence rates of esophageal cancer stratified by sex and histological type in the U.S. (1973–2015). (^) Indicates the annual percent change (APC) that is significantly different from zero (P < 0.05). Male/Squamous – 1 Joinpoint, 1973–1985 APC = −0.15, 1985–2015 APC = −3.49^; Male/Adenocarcinoma – 1 Joinpoint, 1973–1998 APC = 8.25^, 1998–2015 APC = 0.59^, Female/Squamous – 1 Joinpoint, 1973–1986 APC = −0.96, 1986–2015 APC = −2.52^, Female/Adenocarcinoma – 1 Joinpoint, 1973–1999 APC = 7.27^, 1999–2015 APC = 0.84.

Figure 7

Joinpoint regression analysis of the five‐year survival trends in (a) esophageal cancer, observed, 1973–1992 APC = 6.28^, 1992–2010 APC = 3.31^, and stratified by (b) sex, Male – 1 Joinpoint, 1973–1992 APC = 7.19^; 1992–2010 APC = 3.42^, Female – 0 Joinpoints, 1973–2010 APC = 3.52^, (c) histology, Squamous – 1 joinpoint, 1973–1985 APC = 8.02^, 1985–2010 APC = 2.92^, Adenocarcinoma – 1 Joinpoint, 1975–2002 APC = 5.44^, 2002–2010 APC = 1.50, or (d) stage, Localised – 1 Joinpoint, 1973–1983 APC = 11.06^, 1983–2010 APC = 4.45^, Regional – 0 Joinpoints, 1973–2010 APC = 5.48^, Distant – invalid data. (^) Indicates the annual percent change (APC) that is significantly different from zero (P < 0.05).