Esophageal cancer: adenocarcinoma in populations dominated by squamous cell histology

Abstract

Background

Esophageal adenocarcinoma (AC) predominates in the United States but remains uncommon in African Americans and Japanese patients. To gain insight into the behavior of AC in African American and Japanese patients, we evaluated clinical and molecular features of AC in both.

Methods

Data from 7541 AC patients from 38 states (1999–2002) were compared with 2016 AC patients from Maryland (1994–2004) and 659 AC patients from Johns Hopkins Hospital (JHH) from 1984 to 2002. Survival for Caucasians and African Americans was compared. Japanese AC patients who underwent curative surgery at JHH (n = 57) and Juntendo University Hospital (n = 20) were evaluated for clinical and molecular features and compared.

Results

Incidence of AC among African Americans versus Caucasians was low (nationally, 6.8% vs. 62.4%; regionally, 15.4% vs. 82.6%; locally, 3.8% vs. 96.2%). Three-year survival for African Americans treated at JHH was worse than for Caucasians (4% vs. 28%: P < 0.001). Risk factors, with the exception of annual income, were similar. Clinical features of AC in Japanese and U.S. patients were similar, including epidemiological distribution as well as survival. Methylation frequencies were similar for each gene between groups.

Conclusions

The proportion of African Americans with AC versus Caucasians in the United States remains low; however, survival is worse among African Americans. Clinical and molecular features of AC in U.S. and Japanese patients were similar. These data provide early information regarding AC in the two populations in which SCC predominates, which may lead to a better understanding of the biology of and treatment for AC in these populations.