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Survival Disparities by Race and Ethnicity in Early Esophageal Cancer

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Abstract

Background

Survival outcome disparities among esophageal cancer patients exist, but are not fully understood.

Aims

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival differences among racial/ethnic patient populations persist after adjusting for demographic and clinical characteristics.

Methods

Our study included T1-3N0M0 adenocarcinoma and squamous cell cancer patients diagnosed between 2003 and 2011. We compared survival among two racial/ethnic patient subgroups using Cox proportional hazards methods, adjusting for age, sex, histology, marital status, socioeconomics, SEER region, comorbidities, T stage, tumor location, diagnosis year, and treatment received.

Results

Among 2025 patients, 87.9% were White and 12.1% were Nonwhite. Median survival was 18.7 months for Whites vs 13.8 months for Nonwhites (p = 0.01). In the unadjusted model, Nonwhite patients had higher risk of mortality (HR = 1.29, 95% CI 1.11–1.49, p < 0.0001) when compared to White patients; however, in the Cox regression adjusted model there was no significant difference (HR = 0.94, 95% CI 0.80–1.10, p = 0.44). Surgery, chemotherapy, younger age, lower T stage, and lower Charlson comorbidity score were significant predictors in the full adjusted model.

Conclusions

Differences in mortality risk by race/ethnicity appear to be largely explained by additional factors. In particular, associations were seen in surgery and T stage. Further research is needed to understand potential mechanisms underlying the differences and to better target patients who can benefit from treatment options.

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Funding

NIH R01 CA140574

Author information

Authors and Affiliations

  1. Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA

    Angela C. Tramontano, Nathaniel D. Mercaldo, Chung Yin Kong & Chin Hur

  2. Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, USA

    Ryan Nipp

  3. Harvard Medical School, Boston, USA

    Nathaniel D. Mercaldo, Chung Yin Kong & Chin Hur

  4. Department of Radiology, Massachusetts General Hospital Cancer Center, Boston, USA

    Nathaniel D. Mercaldo

  5. Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA

    Deborah Schrag

  6. Gastrointestinal Division, Harvard Medical School, Boston, USA

    Chin Hur

Authors
  1. Angela C. Tramontano
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  2. Ryan Nipp
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  3. Nathaniel D. Mercaldo
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  4. Chung Yin Kong
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  5. Deborah Schrag
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  6. Chin Hur
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Correspondence to Chin Hur.

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Tramontano, A.C., Nipp, R., Mercaldo, N.D. et al. Survival Disparities by Race and Ethnicity in Early Esophageal Cancer. Dig Dis Sci 63, 2880–2888 (2018). https://doi.org/10.1007/s10620-018-5238-6

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  • DOI: https://doi.org/10.1007/s10620-018-5238-6

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