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Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 2880–2888 | Cite as

Survival Disparities by Race and Ethnicity in Early Esophageal Cancer

  • Angela C. Tramontano
  • Ryan Nipp
  • Nathaniel D. Mercaldo
  • Chung Yin Kong
  • Deborah Schrag
  • Chin Hur
Original Article

Abstract

Background

Survival outcome disparities among esophageal cancer patients exist, but are not fully understood.

Aims

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival differences among racial/ethnic patient populations persist after adjusting for demographic and clinical characteristics.

Methods

Our study included T1-3N0M0 adenocarcinoma and squamous cell cancer patients diagnosed between 2003 and 2011. We compared survival among two racial/ethnic patient subgroups using Cox proportional hazards methods, adjusting for age, sex, histology, marital status, socioeconomics, SEER region, comorbidities, T stage, tumor location, diagnosis year, and treatment received.

Results

Among 2025 patients, 87.9% were White and 12.1% were Nonwhite. Median survival was 18.7 months for Whites vs 13.8 months for Nonwhites (p = 0.01). In the unadjusted model, Nonwhite patients had higher risk of mortality (HR = 1.29, 95% CI 1.11–1.49, p < 0.0001) when compared to White patients; however, in the Cox regression adjusted model there was no significant difference (HR = 0.94, 95% CI 0.80–1.10, p = 0.44). Surgery, chemotherapy, younger age, lower T stage, and lower Charlson comorbidity score were significant predictors in the full adjusted model.

Conclusions

Differences in mortality risk by race/ethnicity appear to be largely explained by additional factors. In particular, associations were seen in surgery and T stage. Further research is needed to understand potential mechanisms underlying the differences and to better target patients who can benefit from treatment options.

Keywords

Esophageal cancer Disparities SEER-Medicare Outcomes Survival 

Notes

Funding

NIH R01 CA140574

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Angela C. Tramontano
    • 1
  • Ryan Nipp
    • 2
  • Nathaniel D. Mercaldo
    • 1
    • 3
    • 4
  • Chung Yin Kong
    • 1
    • 3
  • Deborah Schrag
    • 5
  • Chin Hur
    • 1
    • 3
    • 6
  1. 1.Institute for Technology AssessmentMassachusetts General HospitalBostonUSA
  2. 2.Department of Medicine, Division of Hematology and OncologyMassachusetts General Hospital Cancer CenterBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Department of RadiologyMassachusetts General Hospital Cancer CenterBostonUSA
  5. 5.Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  6. 6.Gastrointestinal DivisionHarvard Medical SchoolBostonUSA

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