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Predictors of survival among patients diagnosed with adenocarcinoma of the esophagus and gastroesophageal junction

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Abstract

Purpose

Patients diagnosed with esophageal adenocarcinoma (EAC) or gastroesophageal junction adenocarcinoma (GEJAC) have poor survival. We investigated the possible influence of pre-morbid lifestyle factors on survival for these lethal cancers.

Methods

This study included a population-based cohort of patients with EAC (n = 362) and GEJAC (n = 421) tumors. Detailed information about demographic and lifestyle factors was obtained around the time of diagnosis, and deaths were identified using the National Death Index. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated from Cox proportional hazards models, adjusted for age, sex, pre-treatment American Joint Committee on Cancer tumor stage, treatment and presence of comorbidities.

Results

Median follow-up for mortality was 6.4 years. Five-year survival rates were 27 and 33% for EAC and GEJAC, respectively. As expected, tumor and treatment characteristics were the strongest predictors of survival for both cancer sites. Among patients diagnosed with GEJAC tumors, those who were older (≥70 years, adjusted HR = 1.70, 95% CI 1.24–2.32) and those who reported being current smokers (adjusted HR = 1.45, 95% CI 1.02–2.06) fared worse. Other lifestyle factors putatively associated with risk of developing GEJAC including body mass index, gastroesophageal reflux symptoms, alcohol, and use of non-steroidal anti-inflammatory drugs were not associated with survival. Likewise, after adjusting for stage and treatment, no clear associations were detected between lifestyle factors and survival among patients with EAC tumors. We found similar results for analyses restricted to patients treated surgically.

Conclusions

Overall, our data suggest that lifestyle factors do not appear to unduly influence survival for these cancers.

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Acknowledgments

The authors acknowledge assistance from Dr. Shahram Sadeghi and Dr. Harish Babu for pathology abstractions, and Ms Anne Russell and Dr. Nirmala Pandeya for data cleaning and programming. This study was supported by the Cancer Council Queensland and the National Health and Medical Research Council of Australia (NHMRC) (Program no. 199600; Project 389820). APT is supported by an Australian Postgraduate Award (University of Queensland) and the Cancer Council NSW STREP grant 08-04. CMN is supported by a Research Fellowship from the NHMRC, and DCW is supported by a Future Fellowship from the Australian Research Council. The funding bodies played no role in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Population Health Department, Queensland Institute of Medical Research, 300 Herston Road, Herston, QLD, 4006, Australia

    Aaron P. Thrift, Christina M. Nagle, Paul P. Fahey & David C. Whiteman

  2. School of Population Health, The University of Queensland, Public Health Building, Herston Road, Herston, QLD, 4006, Australia

    Aaron P. Thrift

  3. Division of Surgery, Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, QLD, 4012, Australia

    Bernard M. Smithers

  4. Department of Surgery, Flinders University, Adelaide, SA, 5042, Australia

    David I. Watson

  5. Cancer Control Laboratory, Queensland Institute of Medical Research, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, QLD, 4029, Australia

    David C. Whiteman

Authors
  1. Aaron P. Thrift
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  2. Christina M. Nagle
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  3. Paul P. Fahey
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  4. Bernard M. Smithers
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  5. David I. Watson
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  6. David C. Whiteman
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Corresponding author

Correspondence to David C. Whiteman.

Additional information

This study is conducted for the Australian Cancer Study Clinical Follow-Up Study. The details are given in the "Appendix" Section.

Appendix: Contributors

Appendix: Contributors

The following contributed to the Australian Cancer Study Clinical Follow-Up Study: Investigators: D. C. Whiteman, A. C. Green, D. Gotley, B. M. Smithers, D. I. Watson, G. L. Falk, G. Smith, G. Kiroff, S. Archer, N. K. Hayward, A. Clouston. Project Managers: T. Corish, S. Moore. Database: K. Harrap, T. Sadkowski. Research Nurses: J. Thomas, E. Minehan, D. Roffe, S. O’Keefe, S. Lipshut, G. Connor, H. Berry, L. Terry, M. Connard, L. Bowes, M. R. Malt, J. White. Clinical Contributors: C. Mosse, N. Tait (Australian Capital Territory); C. Bambach, A. Biankan, R. Brancatisano, M. Coleman, M. Cox, S. Deane, J. Gallagher, M. Hollands, T. Hugh, D. Hunt, J. Jorgensen, C. Martin, M. Richardson, R. Smith, D. Storey (New South Wales); J. Avramovic, J. Croese, J. D’Arcy, S. Fairley, J. Hansen, J. Masson, I. Martin, L. Nathanson, B. O’Loughlin, L. Rutherford, R. Turner, M. Windsor (Queensland); J. Bessell, P. Devitt, G. Jamieson (South Australia); S. Blamey, A. Boussioutas, R. Cade, G. Crosthwaite, I. Faragher, J. Gribbin, G. Hebbard, B. Mann, B. Millar, P. O’Brien, R. Thomas, S. Wood (Victoria); K. Faulkner, J. Hamdorf (Western Australia).

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Thrift, A.P., Nagle, C.M., Fahey, P.P. et al. Predictors of survival among patients diagnosed with adenocarcinoma of the esophagus and gastroesophageal junction. Cancer Causes Control 23, 555–564 (2012). https://doi.org/10.1007/s10552-012-9913-1

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  • DOI: https://doi.org/10.1007/s10552-012-9913-1

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