Elsevier

Mayo Clinic Proceedings

Volume 83, Issue 10, October 2008, Pages 1087-1094
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Survival Trends in Patients With Gastric and Esophageal Adenocarcinomas: A Population-Based Study

https://doi.org/10.4065/83.10.1087Get rights and content

OBJECTIVE

To use a population-based approach to describe survival trends in patients diagnosed as having gastric or esophageal adenocarcinoma.

PATIENTS AND METHODS

A population-based complete chart review of all inpatient and outpatient records, using the resources of the Rochester Epidemiology Project, was conducted in Olmsted County, Minnesota (population 124,277), a primarily rural county with one large urban area. All residents of Olmsted County who were diagnosed as having gastric or esophageal adenocarcinoma from January 1, 1971, through December 31, 2000, were included in the study. The main outcomes were median survival and 2-year and 5-year survival rates, by decade of diagnosis.

RESULTS

From 1971 through 2000, median survival for patients with gastric adenocarcinoma (n=121) decreased from 5.5 months to 3.2 months, whereas median survival for patients with esophageal adenocarcinoma (n=65) increased from 8.5 months to 11.7 months. Decade of diagnosis was not significantly associated with patient survival for either gastric or esophageal adenocarcinoma (P>.05). There was no significant shift in stage of disease at diagnosis during the 30-year period for either gastric or esophageal adenocarcinoma (P>.05).

CONCLUSION

No significant change has occurred in the survival rates of this patient population with gastric or esophageal adenocarcinoma, which is representative of the US white population.

Section snippets

PATIENTS AND METHODS

Medical care for residents of Olmsted County, situated in primarily rural southeastern Minnesota, is provided almost exclusively by 2 group practices: Mayo Clinic and Olmsted Medical Center and their affiliated hospitals and clinics. The Rochester Epidemiology Project (REP) is a medical records linkage system that allows for access to the complete medical records of these health care institutions—including inpatient, outpatient, nursing home, emergency department, pathologic, radiologic, and

RESULTS

During the 30-year study period, 186 residents of Olmsted County were diagnosed as having gastric or esophageal adenocarcinoma. Of these patients, 121 (65%) had adenocarcinomas originating in the stomach, and 65 (35%) had adenocarcinomas originating in the esophagus or esophagogastric junction.

The median survival time for patients with gastric adenocarcinoma decreased during the 3 decades studied, from 5.5 months in the 1970s to 4.1 months in the 1980s to 3.2 months in the 1990s. The 2-year

DISCUSSION

In this population-based study of all cases of gastric and esophageal adenocarcinoma diagnosed in Olmsted County, we found no significant change in patient survival during 3 decades. There was no significant improvement in survival despite advances in screening, diagnosis, and treatment during this same period.

Median survival of patients with gastric adenocarcinoma actually appeared to decrease between 1971 and 2000. Patient survival for both diseases has remained dismal. Median survival of

CONCLUSION

In this population-based study, we have shown that, despite advances in diagnostic tools and refinements in surgical techniques, survival of patients with adenocarcinoma of the stomach or esophagus has not improved during the past 3 decades. Current efforts at cancer prevention and early screening of high-risk populations for premalignant lesions, such as Barrett esophagus, have not resulted in a significant change in the stage of presentation of disease in the studied community, possibly

REFERENCES (32)

  • WJ Blot et al.

    Rising incidence of adenocarcinoma of the esophagus and gastric cardia

    JAMA

    (1991)
  • SJ Crane et al.

    The changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site

    Aliment Pharmacol Ther

    (2007)
  • SJ Murphy et al.

    Surveillance for Barrett's oesophagus: results from a programme in Northern Ireland

    Eur J Gastroenterol Hepatol

    (2005)
  • KP McKian et al.

    Curing patients with locally advanced esophageal cancer: an update on multimodality therapy

    Dis Esophagus

    (2006)
  • MJ Dalrymple-Hay et al.

    Oesophagectomy for carcinoma of the oesophagus and oesophagogastric junction

    Eur J Cardiothorac Surg

    (1999)
  • LS Jensen et al.

    Outcome after transthoracic resection of carcinoma of the oesophagus and oesophagogastric junction

    Scand J Surg

    (2005)

    • Cited by (48)

    • Predictors of pathologic upstaging in early esophageal adenocarcinoma: Results from the national cancer database

      2018, American Journal of Surgery
      Citation Excerpt :

      In addition, EAC has the fastest rising incidence rate of any cancer with approximately a 10-fold increased incidence rate among men aged 15–74 over the last 40 years.3,4 Unfortunately, little progress has been made in treating this extremely aggressive cancer, with median survival time increasing only 3.2 months over the last 30 years.5 Recently, endoscopic ultrasound (EUS), along with computed tomography (CT), has become a standard component of preoperative staging that has an important role in directing treatment, either via endoluminal techniques such as endoscopic mucosal dissection/endoscopic mucosal resection (EMD/EMR) or formal esophagectomy, for early esophageal cancers depending on the detection of depth of invasion as well as lymph node status.6

    • Role of positron emission tomography-computed tomography in gastrointestinal malignancies

      2013, Radiologic Clinics of North America
      Citation Excerpt :

      At present, the only cure is complete resection of the tumor and any involved regional lymph nodes. Many patients unfortunately present with advanced disease, with only 25% of European and United States patients in 2 studies, and only 5% of patients in a high-risk population from South America, presenting with Stage I or Stage II disease.49–51 Treatment options for those with advanced disease are limited to palliative chemotherapy or neoadjuvant therapy with the goal of downstaging the carcinoma.

    • Where are we in the treatment of gastric cancer? Experiences and evidences 30 years later

      2013, Medicina Clinica

    • Downregulation of SODD mediates carnosol-induced reduction in cell proliferation in esophageal adenocarcinoma cells

      2023, Scientific Reports

    • Efficacy and safety of Nivolumab in patients with advanced esophageal, gastroesophageal, and gastric cancers: a meta-analysis of randomized controlled trials

      2023, Immunopharmacology and Immunotoxicology

    • Incidence, Survival and Prognostic Factors of Oesophagogastric Cancer

      2022, Journal of Gastrointestinal Cancer
    View all citing articles on Scopus

    This study was supported by a clinical research grant from the American College of Gastroenterology. The Rochester Epidemiology Project is supported by National Institutes of Health grant RO 1AR30582. Dr Romero's participation was supported in part by National Institutes of Health grant NIDDK 02956.

    View full text
    Copyright © 2008 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.