Abstract
BACKGROUND: Esophageal cancer is a significant global health concern, characterized by high mortality rates and diverse histological types, primarily adenocarcinoma and squamous cell carcinoma. AIM: To analyze trends in esophageal cancer using Surveillance, Epidemiology, and End Results (SEER) data, focusing on patient characteristics, stage at diagnosis, treatment modalities, and survival outcomes, to provide insights that may guide clinical practice and public health initiatives. METHODS: Age-adjusted incidence and mortality rates for esophageal cancer, 2004-2021, were obtained from SEER rate sessions using SEER*Stat version 8.4.4. Average percent changes (APC) over time in age-adjusted incidence and mortality rates relative to gender, race/ethnicity, and stage at diagnosis were assessed using Joinpoint's log-linear regression. Finally, Poisson regression was used to ascertain incidence and mortality rate ratios to ascertain associations between age, gender, race/ethnicity, and staging with incidence and mortality rates. All analyses were further stratified by gender to assess interactions between gender and the other demographic and clinical characteristics. RESULTS: Overall, the data reveals significant trends in both the incidence and mortality rates of esophageal cancer, with notable variations across gender, race, and stage at diagnosis. Age-adjusted incidence and mortality rates were higher in males compared to females (incidence: 4.1 per 100000 vs 0.9 per 100000, mortality: 3.4 per 100000 vs 0.7 per 100000), P < 0.001. Furthermore, the APC among males decreased more significantly over time [APC (95%CI): -1.14 (-1.52 to -0.78); P < 0.001]. Both non-Hispanic (NH) Blacks and NH Whites showed significant decreases in cancer incidence, with NH Blacks observing a 3.27% decline and NH Whites a 0.51% decline. Patients with distant staging had a 5% APC increase in mortality rates over time (P = 0.003). Additionally, mortality rates increased with age, and all minority groups showed declines in incidence and mortality compared to NH Whites. Cancer diagnosed at a distant stage had a mortality rate 4.16 times higher than in situ cases. CONCLUSION: The analysis reveals clear disparities in both the incidence and mortality of esophageal cancer, with males, particularly NH Whites, experiencing significantly higher rates than females. Despite a general decline in incidence rates over time, the upward trend in mortality for certain subgroups warrants further investigation into potential contributing factors such as healthcare access, treatment efficacy, and underlying socio-economic disparities.