World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 11, Number 2, April 2020, pages 55-64

Esophageal Cancer: An Updated Surveillance Epidemiology and End Results Database Analysis

Figure 1. Annual incidence rate of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC).

Figure 2. Kaplan-Meier curve for cause specific and relative survival for esophageal adenocarcinoma (EAC).

Figure 3. Kaplan-Meier curve for cause specific and relative survival for esophageal squamous cell carcinoma (ESCC).

**Table 1.** Baseline Demographic Characteristics of Esophageal Adenocarcinoma and Squamous Cell Carcinoma
Variable	Total EAC (n, %)	Total ESCC (n, %)
EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.
Sex
Male	20,700 (86.96%)	9,156 (65.78%)
Female	3,104 (13.04%)	4,763 (34.22%)
Race
White	20,951 (88.01%)	7,754 (55.71%)
Black	649 (2.73%)	3,649 (26.22%)
Hispanic	1,612 (6.77%)	1,148 (8.25%)
Asian or Pacific Islander	417 (1.75%)	1,257 (9.03%)
American Indian/Alaskan Native	124 (0.52%)	92 (0.66%)
Unknown	51 (0.21%)	19 (0.14%)
Region
Pacific Coast	10,098 (42.42%)	5,940 (42.68%)
East	9,553 (40.13%)	6,286 (45.16)
Northern Plains	2,959 (12.43%)	1,274 (9.15%)
Southwest	1,167 (4.90%)	378 (2.72%)
Alaska	27 (0.11%)	41 (0.29%)

Table 1. Baseline Demographic Characteristics of Esophageal Adenocarcinoma and Squamous Cell Carcinoma

Variable

Total EAC (n, %)

Total ESCC (n, %)

EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.

Sex

Male

20,700 (86.96%)

9,156 (65.78%)

Female

3,104 (13.04%)

4,763 (34.22%)

Race

White

20,951 (88.01%)

7,754 (55.71%)

Black

649 (2.73%)

3,649 (26.22%)

Hispanic

1,612 (6.77%)

1,148 (8.25%)

Asian or Pacific Islander

417 (1.75%)

1,257 (9.03%)

American Indian/Alaskan Native

124 (0.52%)

92 (0.66%)

Unknown

51 (0.21%)

19 (0.14%)

Region

Pacific Coast

10,098 (42.42%)

5,940 (42.68%)

East

9,553 (40.13%)

6,286 (45.16)

Northern Plains

2,959 (12.43%)

1,274 (9.15%)

Southwest

1,167 (4.90%)

378 (2.72%)

Alaska

27 (0.11%)

41 (0.29%)

**Table 2.** Tumor Characteristics for Esophageal Adenocarcinoma and Squamous Cell Carcinoma
Variable	Total EAC (n, %)	Total ESCC (n, %)
EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.
Tumor grade
Well differentiated; grade I	1,227 (5.15%)	651 (4.68%)
Moderately differentiated; grade II	7,987 (33.55%)	5,500 (39.51%)
Poorly differentiated; grade III	10,007 (42.04%)	4,881 (35.07%)
Undifferentiated; anaplastic; grade IV	279 (1.17%)	106 (0.76%)
Unknown	4,304 (18.09%)	2,781 (19.98%)
Stage
Stage I	4,009 (16.84%)	1,988 (14.28%)
Stage II	4,039 (16.97%)	2,748 (19.74%)
Stage III	4,355 (18.30%)	3,091 (22.21%)
Stage IV	8,806 (36.99%)	3,731 (26.81%)
Unknown	2,595 (10.90%)	2,361 (16.96%)
T staging
T1	6,932 (29.12%)	3,631 (26.09%)
T2	2,265 (9.52%)	1,234 (8.87%)
T3	7,002 (29.42%)	3,581 (25.73%)
T4	2,442 (10.26%)	2,269 (16.30%)
Unknown	5,163 (21.69%)	3,204 (23.02%)
N staging
N0	13,014 (54.67%)	7,763 (55.77%)
N1	10,790 (45.33%)	6,156 (44.23%)
Location
Upper esophagus	288 (1.21%)	2,643 (18.99%)
Middle esophagus	1,846 (7.75%)	5,444 (39.11%)
Lower esophagus	18,785 (78.92%)	3,755 (26.98%)
Overlapping lesion	2,885 (12.12%)	2,077 (14.92%)
Surgery
Surgery performed	7,831 (32.90%)	2,214 (15.91%)
No surgery performed	15,973 (67.10%)	11,705 (84.09%)
Radiation
Radiation given	12,440 (52.26%)	8,515 (61.18%)
No radiation given	11,364 (47.74%)	5,404 (38.82%)
Chemotherapy
Chemotherapy given	14,830 (62.30%)	8,384 (60.23%)
No chemotherapy given	8,974 (37.70%)	5,535 (39.77%)

Table 2. Tumor Characteristics for Esophageal Adenocarcinoma and Squamous Cell Carcinoma

Variable

Total EAC (n, %)

Total ESCC (n, %)

EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.

Tumor grade

Well differentiated; grade I

1,227 (5.15%)

651 (4.68%)

Moderately differentiated; grade II

7,987 (33.55%)

5,500 (39.51%)

Poorly differentiated; grade III

10,007 (42.04%)

4,881 (35.07%)

Undifferentiated; anaplastic; grade IV

279 (1.17%)

106 (0.76%)

Unknown

4,304 (18.09%)

2,781 (19.98%)

Stage

Stage I

4,009 (16.84%)

1,988 (14.28%)

Stage II

4,039 (16.97%)

2,748 (19.74%)

Stage III

4,355 (18.30%)

3,091 (22.21%)

Stage IV

8,806 (36.99%)

3,731 (26.81%)

Unknown

2,595 (10.90%)

2,361 (16.96%)

T staging

6,932 (29.12%)

3,631 (26.09%)

2,265 (9.52%)

1,234 (8.87%)

7,002 (29.42%)

3,581 (25.73%)

2,442 (10.26%)

2,269 (16.30%)

Unknown

5,163 (21.69%)

3,204 (23.02%)

N staging

13,014 (54.67%)

7,763 (55.77%)

10,790 (45.33%)

6,156 (44.23%)

Location

Upper esophagus

288 (1.21%)

2,643 (18.99%)

Middle esophagus

1,846 (7.75%)

5,444 (39.11%)

Lower esophagus

18,785 (78.92%)

3,755 (26.98%)

Overlapping lesion

2,885 (12.12%)

2,077 (14.92%)

Surgery

Surgery performed

7,831 (32.90%)

2,214 (15.91%)

No surgery performed

15,973 (67.10%)

11,705 (84.09%)

Radiation

Radiation given

12,440 (52.26%)

8,515 (61.18%)

No radiation given

11,364 (47.74%)

5,404 (38.82%)

Chemotherapy

Chemotherapy given

14,830 (62.30%)

8,384 (60.23%)

No chemotherapy given

8,974 (37.70%)

5,535 (39.77%)

**Table 3.** Survival of Patients with Esophageal Adenocarcinoma and Squamous Cell Carcinoma
Survival	EAC	ESCC
EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.
Relative
1-year	52.3%	41.4%
5-year	21.3%	15.9%
Median	13 months	9 months
Cause-specific
1-year	54.4%	43.8%
5-year	23.4%	18.9%
Median	15 months	10 months

Table 3. Survival of Patients with Esophageal Adenocarcinoma and Squamous Cell Carcinoma

Survival

EAC

ESCC

EAC: esophageal adenocarcinoma; ESCC: esophageal squamous cell carcinoma.

Relative

1-year

52.3%

41.4%

5-year

21.3%

15.9%

Median

13 months

9 months

Cause-specific

1-year

54.4%

43.8%

5-year

23.4%

18.9%

Median

15 months

10 months

**Table 4.** Hazard Ratios for Esophageal Adenocarcinoma
Variable	Hazard ratio	95% Confidence interval	P value
Age at diagnosis	1.012	1.010 - 1.013	0.000
Sex
Male	1.00
Female	0.932	0.892 - 0.975	0.002
Race
White	1.00
Black	1.091	0.996 - 1.194	0.061
Hispanic	1.023	0.963 - 1.086	0.450
Asian/Pacific Islander	0.862	0.769 - 0.967	0.012
American Indian/Alaskan	1.143	0.929 - 1.407	0.205
Location
Upper esophagus	1.00
Middle esophagus	1.202	1.037 - 1.395	0.014
Lower esophagus	1.123	0.977 - 1.291	0.101
Overlapping lesion	1.177	1.019 - 1.361	0.027
Tumor size	0.999	0.999 - 1.000	0.812
Grade
Grade I	1.00
Grade II	1.226	1.134 - 1.325	0.000
Grade III	1.563	1.447 - 1.689	0.000
Grade IV	1.404	1.204 - 1.637	0.000
Unknown	1.117	1.029 - 1.212	0.008
Stage
Stage I	1.00
Stage II	1.962	1.821 - 2.115	0.000
Stage III	2.447	2.247 - 2.666	0.000
Stage IV	3.587	3.336 - 3.857	0.000
Unknown	1.669	1.539 - 1.809	0.000
T - stage
T1	1.00
T2	0.765	0.713 - 0.820	0.000
T3	0.895	0.848 - 0.945	0.000
T4	1.109	1.041 - 1.182	0.001
Unknown	1.171	1.108 - 1.238	0.000
N - stage
N0	1.00
N1	1.078	1.039 - 1.118	0.000
Unknown
Surgery
Surgery performed	1.00
No surgery performed	2.545	2.443 - 2.652	0.000
Radiation
Radiation given	1.00
No radiation given	0.917	0.884 - 0.950	0.000
Chemotherapy
Chemotherapy given	1.000
No chemotherapy given	1.689	1.622 - 1.758	0.000

Table 4. Hazard Ratios for Esophageal Adenocarcinoma

Variable

Hazard ratio

95% Confidence interval

P value

Age at diagnosis

1.012

1.010 - 1.013

0.000

Sex

Male

1.00

Female

0.932

0.892 - 0.975

0.002

Race

White

1.00

Black

1.091

0.996 - 1.194

0.061

Hispanic

1.023

0.963 - 1.086

0.450

Asian/Pacific Islander

0.862

0.769 - 0.967

0.012

American Indian/Alaskan

1.143

0.929 - 1.407

0.205

Location

Upper esophagus

1.00

Middle esophagus

1.202

1.037 - 1.395

0.014

Lower esophagus

1.123

0.977 - 1.291

0.101

Overlapping lesion

1.177

1.019 - 1.361

0.027

Tumor size

0.999

0.999 - 1.000

0.812

Grade

Grade I

1.00

Grade II

1.226

1.134 - 1.325

0.000

Grade III

1.563

1.447 - 1.689

0.000

Grade IV

1.404

1.204 - 1.637

0.000

Unknown

1.117

1.029 - 1.212

0.008

Stage

Stage I

1.00

Stage II

1.962

1.821 - 2.115

0.000

Stage III

2.447

2.247 - 2.666

0.000

Stage IV

3.587

3.336 - 3.857

0.000

Unknown

1.669

1.539 - 1.809

0.000

T - stage

1.00

0.765

0.713 - 0.820

0.000

0.895

0.848 - 0.945

0.000

1.109

1.041 - 1.182

0.001

Unknown

1.171

1.108 - 1.238

0.000

N - stage

1.00

1.078

1.039 - 1.118

0.000

Unknown

Surgery

Surgery performed

1.00

No surgery performed

2.545

2.443 - 2.652

0.000

Radiation

Radiation given

1.00

No radiation given

0.917

0.884 - 0.950

0.000

Chemotherapy

Chemotherapy given

1.000

No chemotherapy given

1.689

1.622 - 1.758

0.000

**Table 5.** Hazard Ratios for Esophageal Squamous Cell Carcinoma
Variable	Hazard ratio	95% Confidence interval	P value
Age at diagnosis	1.005	1.003 - 1.007	0.000
Sex
Male	1.00
Female	0.833	0.800 - 0.0868	0.000
Race
White	1.00
Black	1.117	1.068 - 1.169	0.000
Hispanic	0.937	0.872 - 1.006	0.076
Asian/Pacific Islander	0.893	0.833 - 0.956	0.001
American Indian/Alaskan	1.061	0.836 - 1.346	0.623
Location
Upper esophagus	1.00
Middle esophagus	1.126	1.068 - 1.188	0.000
Lower esophagus	1.127	1.063 - 1.195	0.000
Overlapping lesion	1.210	1.132 - 1.293	0.000
Tumor size	1.000	0.999 - 1.000	0.400
Grade
Grade I	1.00
Grade II	1.322	1.200 - 1.457	0.000
Grade III	1.358	1.231 - 1.497	0.000
Grade IV	1.169	0.923 - 1.480	0.194
Unknown	1.161	1.048 - 1.285	0.004
Stage
Stage I	1.00
Stage II	1.266	1.158 - 1.384	0.000
Stage III	1.431	1.287 - 1.592	0.000
Stage IV	2.127	1.945 - 2.326	0.000
Unknown	1.273	1.152 - 1.407	0.000
T-stage
T1	1.00
T2	0.816	0.745 - 0.893	0.000
T3	0.946	0.880 - 1.017	0.133
T4	1.346	1.241 - 1.460	0.000
Unknown	1.064	0.984 - 1.150	0.116
N-stage
N0	1.00
N1	1.045	0.998 - 1.094	0.060
Unknown
Surgery
Surgery performed	1.00
No surgery performed	2.370	2.226 - 2.52	0.000
Radiation
Radiation given	1.00
No radiation given	1.319	1.258 - 1.384	0.000
Chemotherapy
Chemotherapy given	1.00
No chemotherapy given	1.840	1.755 - 1.930	0.000

Table 5. Hazard Ratios for Esophageal Squamous Cell Carcinoma

Variable

Hazard ratio

95% Confidence interval

P value

Age at diagnosis

1.005

1.003 - 1.007

0.000

Sex

Male

1.00

Female

0.833

0.800 - 0.0868

0.000

Race

White

1.00

Black

1.117

1.068 - 1.169

0.000

Hispanic

0.937

0.872 - 1.006

0.076

Asian/Pacific Islander

0.893

0.833 - 0.956

0.001

American Indian/Alaskan

1.061

0.836 - 1.346

0.623

Location

Upper esophagus

1.00

Middle esophagus

1.126

1.068 - 1.188

0.000

Lower esophagus

1.127

1.063 - 1.195

0.000

Overlapping lesion

1.210

1.132 - 1.293

0.000

Tumor size

1.000

0.999 - 1.000

0.400

Grade

Grade I

1.00

Grade II

1.322

1.200 - 1.457

0.000

Grade III

1.358

1.231 - 1.497

0.000

Grade IV

1.169

0.923 - 1.480

0.194

Unknown

1.161

1.048 - 1.285

0.004

Stage

Stage I

1.00

Stage II

1.266

1.158 - 1.384

0.000

Stage III

1.431

1.287 - 1.592

0.000

Stage IV

2.127

1.945 - 2.326

0.000

Unknown

1.273

1.152 - 1.407

0.000

T-stage

1.00

0.816

0.745 - 0.893

0.000

0.946

0.880 - 1.017

0.133

1.346

1.241 - 1.460

0.000

Unknown

1.064

0.984 - 1.150

0.116

N-stage

1.00

1.045

0.998 - 1.094

0.060

Unknown

Surgery

Surgery performed

1.00

No surgery performed

2.370

2.226 - 2.52

0.000

Radiation

Radiation given

1.00

No radiation given

1.319

1.258 - 1.384

0.000

Chemotherapy

Chemotherapy given

1.00

No chemotherapy given

1.840

1.755 - 1.930

0.000