Don C. Codipilly, MD1, Tarek Sawas, MD1, Lovekirat Dhaliwal, MBBS1, Jacob Lui, BS2, David A. Katzka, MD1, Prasad G. Iyer, MD, MS1; 1Mayo Clinic, Rochester, MN; 2Mayo Clinic College of Medicine, Rochester, MN
Introduction: The incidence of esophageal adenocarcinoma (EAC) has drastically increased over the last few decades. Although EAC is typically perceived as a disease affecting Caucasian populations, its impact on minority populations is unclear. We aimed to assess EAC outcomes regarding incidence, therapy, and survival in minority populations. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) 18 database to identify patients with EAC in the time period 2004-2015. We analyzed disease stage at presentation, receipt of therapy, and survival (EAC free and overall) stratified by race/ethnicity. Stage at diagnosis was categorized according to AJCC version 6 criteria. Multivariate models were created to identify predictors of survival. Results: We identified 25,393 patients for inclusion in the study. Basic demographics are presented in table 1, and minority patients made up 11.7% of the cohort. White patients presented at an older age compared to minority populations (67.6 years vs 64.3 years; p< 0.05). Despite this, African-Americans were more likely than Non-Hispanic Whites to present with stage III/IV disease (70.0% vs 65.2%; p< 0.05), to be uninsured at diagnosis (9.8% vs 5.8%, p< 0.05), and to be on Medicaid (20.5% vs 7.8%; p< 0.05). African-Americans were less likely than Non-Hispanic Whites to receive surgery (19.1% vs. 26.6%), endoscopic eradication therapy (3.1% vs. 4.9%), radiation therapy (47.7% vs. 51.3%) or chemotherapy (52.7% vs. 59.6%; p< 0.05 for all comparisons), and this remained statistically significant on stage-stratified analysis. Mean EAC-free survival for African-Americans (35.7 months) was significantly shorter compared to whites (52.9 months; p< 0.05) and Hispanic patients (44.6 months; p< 0.05). Further, mean EAC-free survival for all minorities combined was also significantly lower (44.7 months) compared to whites (p< 0.01; Figure 1). In a multivariate analysis adjusted for age, gender, race, and stage at diagnosis, EAC-specific mortality was higher in African-Americans and Hispanics compared to whites (table 2). Discussion: Despite presenting at a younger age compared to whites, African-Americans are more likely to be diagnosed with advanced EAC, are less likely to receive guideline-directed therapies, and have decreased EAC-free survival. Further study is needed to elucidate factors that underlie disparities in clinical management resulting in poorer EAC outcomes observed in African-Americans.
Table 1. Basic Demographics
Table 2. Multivariate Predictors of Mortality
Figure 1. Kaplan-Meier Curve for Survival (Log-rank <0.01)
Disclosures: Don Codipilly indicated no relevant financial relationships. Tarek Sawas indicated no relevant financial relationships. Lovekirat Dhaliwal indicated no relevant financial relationships. Jacob Lui indicated no relevant financial relationships. David Katzka: Erbe – Advisory Committee/Board Member. Prasad Iyer: Exact Science – Grant/Research Support. Medtronic – Consultant, Grant/Research Support. Nine Point Medical – Grant/Research Support. Pentax Medical – Grant/Research Support. Symple Surgical – Consultant.