Abstract
BACKGROUND: Esophageal cancer (EC) is an aggressive gastrointestinal carcinoma with high morbidity and mortality worldwide. This study was aimed at investigating the influences of T stage in patients with the same III/IV stage, and of various therapeutic modalities in each subgroup of III/IV stage in esophageal adenocarcinoma (EAC). METHODS: Patients diagnosed with EAC between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to select independent prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves were used to determine survival differences according to T stage and treatment strategy in the III/IV stage subgroup. RESULTS: Data from 5,765 EACs were identified. Seven independent risk factors were identified for OS and CSS. Based on T stage, patients with the same III/IV stage showed survival differences in the subgroup analyses in both OS and CSS (P<0.001). The median survival time in T2N1M0 in III stage and T1N2-3M0 in IVA stage was longer compared to the other groups, respectively. Concerning therapy modalities, chemotherapy alone or surgery alone showed a significant difference in terms of CSS in III stage subgroups (P<0.001, P=0.01, respectively), while surgery combined with chemotherapy also showed a significant difference (P=0.02). However, no survival difference was found in the subgroups of IVA stage based on therapy. Finally, chemotherapy plus surgery in early stages of III/IVA subgroups prominently increased the median survival time. CONCLUSIONS: Differences according to T stage may potentially influence EAC survival under the same III/IV stage. Our findings implied that higher T stage was associated with poorer prognosis among patients in the same III/IVA stage. Meanwhile, it was advised for patients to receive surgery plus chemotherapy in the early subgroups of III/IVA stage.