Clin Endosc.  2022 May;55(3):372-380. 10.5946/ce.2021.152.

Epidemiology of early esophageal adenocarcinoma

• Hang TVP
• Spiritos Z
• Gamboa AM
• Chen Z
• Force S
• Patel V
• Chawla S
• Keilin S
• Saba NF
• El-Rayes B
• Cai Q
• Willingham FF

• KMID: 2529959
• DOI: http://doi.org/10.5946/ce.2021.152

Abstract

Background/Aims
Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined.
Methods
Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available.
Results
The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%–5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%.
Conclusions
There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

Keyword

Adenocarcinoma; Barrett’s esophagus; Epidemiology; Esophageal neoplasm

Figure

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  Fig. 1. Percent change in annual incidence of major epithelial cancers from 1973–2017 by cancer type relative to the index year. Each epithelial cancer was defined according to the International Classification of Diseases for Oncology (ICO-3)/World Health Organization (WHO) 2008 anatomic locations. The change in the incidence rate for each epithelial malignancy relative to its historic incidence rate in 1973 was represented by the formula: 100 × [(rate at a specific year – 1973 rate) / 1973 rate].

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  Fig. 2. Incidence rate of esophageal adenocarcinoma from 1973–2017 by race and sex. Incidence rates were per 100,000 individuals and age-adjusted to the 2000 US population.

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  Fig. 3. Incidence rate of early (stage 0 and I) vs stage II–IV esophageal adenocarcinoma from 2004–2015. Staging was based on the American Joint Committee on Cancer Staging, 6th edition. Early stage esophageal adenocarcinoma (stage 0–I) is defined as Tis, T1a, and T1b N0 M0 tumors.

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  Fig. 4. Cases of esophageal adenocarcinoma from 2010–2017 by tumor stage. Staging was based on the American Joint Committee on Cancer Staging, 7th edition. a)Indicates that the annual percent change (APC) is significantly from zero at the alpha = 0.05 level. Final selected model, 0 Joinpoints.

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  Fig. 5. Annual percent change in early esophageal adenocarcinoma incidence from 2010 to 2017. Staging was based on the American Joint Committee on Cancer Staging, 7th edition. Each trend segment was based on Joinpoint analyses. Incidence rates were per 100,000 and were age-adjusted to the 2000 standard population.

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