Skip to main content
Log in

Determinants of survival following the diagnosis of esophageal adenocarcinoma (United States)

  • Research Papers
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

The rapidly rising incidence of esophageal adenocarcinomas in the United States and western Europe remains unexplained. Most persons who develop the disease have had long-standing gastroesophageal reflux symptoms with concomitant Barrett's metaplasia. They are, therefore, potentially identifiable for endoscopic screening and cancer surveillance, which should facilitate the early detection of these tumors. We undertook these analyses to determine the extent to which the opportunity for early diagnosis and treatment of esophageal adenocarcinomas has been realized in the US. Specifically, using data from the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, we examined changes in stage of disease at diagnosis and in survival between 1973 and 1991 and investigated patient characteristics as predictors of survival. Improvements in stage at diagnosis and in survival between 1973 and 1991 were minor and clinically insignificant; overall five-year survival never exceeded 10 percent. Stage of disease at diagnosis was the strongest determinant of subsequent survival; five-year survival with patients with in situ tumors was 68.2 percent. This survival advantage persisted up to 15 years after diagnosis and was independent of other prognostic factors. We conclude that the opportunity for reduction in esophageal cancer mortality has been largely unrealized in the US. In light of the increasing incidence of esophageal adenocarcinoma, efforts should be devoted to identifying those at highest risk of developing Barrett's metaplasia and subsequent adenocarcinoma, and to developing cost-effective primary prevention and cancer surveillance methods targetting them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Yang PC, Davis S. Incidence of cancer of the esophagus in the U.S. by histologic type. Cancer 1988; 61: 512–7.

    Google Scholar 

  2. Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev 1992; 1: 265–9.

    Google Scholar 

  3. Blot WJ, Devesa SS, Fraumeni JFJr. Continuing climb in rates of esophageal adenocarcinoma: an update [Letter]. JAMA 1993; 270: 1320.

    Google Scholar 

  4. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265: 1287–9.

    Google Scholar 

  5. Vaughan TL, Davis S, Kristal A, et al. Obesity, alcohol and tobacco as risk factors for cancer of the esophagus: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomark Prev 1995; 4: 85–92.

    Google Scholar 

  6. Brown LM, Swanson CA, Gridley G, et al. Adenocarcinoma of the esophagus: role of obesity and diet. JNCI 1995; 87: 104–9.

    Google Scholar 

  7. Reid BJ. Barrett's esophagus and esophageal adenocarcinoma. Gastroenterol Clin N Am 1991; 20: 817–34.

    Google Scholar 

  8. Gloeckler Ries LA, Hankey BF, Edwards BD, eds. Cancer Statistics Review 1973–87. Bethesda, MD (USA): National Cancer Institute, 1990; DHHS Pub. No. (NIH)90–2789.

    Google Scholar 

  9. World Health Organization. International Classification of Diseases for Oncology, First Edition, Geneva, Switzerland: WHO, 1976.

    Google Scholar 

  10. Percy C, Van Holten V, Muir C, eds. International Classification of Diseases for Oncology, Second Edition. Geneva, Switzerland: World Health Organization, 1990.

    Google Scholar 

  11. Norusis MJ, SPSS Inc. SPSS for Windows. Advanced Statistics. Chicago, IL (USA): SPSS Inc., 1993.

    Google Scholar 

  12. Shambaugh EW, Weiss MA, Axtell LM, eds. Summary Staging Guide: Cancer Surveillance, Epidemiology, and End Results (SEER) Program, Bethesda, MD (USA): National Institutes of Health, 1977; Department of Health, Education, and Welfare. (DHEW) Pub. No. (NIH) 77–1448.

    Google Scholar 

  13. Sarr MG, Hamilton SR, Marrone GC, et al. Barrett's esophagus: Its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux. Am J Surg 1985; 149: 187–93.

    Google Scholar 

  14. Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus. N Engl J Med 1985; 313: 857–9.

    Google Scholar 

  15. Phillips RW, Wong RKH. Barrett's esophagus: natural history, incidence, etiology and complications. Gastroenterol Clin N Am 1991; 20: 791–816.

    Google Scholar 

  16. Streitz JM, Andrews CW, Ellis FH, et al. Endoscopic surveillance of Barrett esophagus-does in help? J Thorac Cardiovasc Surg 1993; 105(3): 393–8.

    Google Scholar 

  17. Provenzale D, Kemp JA, Arora S, Wong JB. A guide for surveillance of patients with Barrett's esophagus. Am J Gastroenterol 1994; 89: 670–9.

    Google Scholar 

Download references


Additional information

Drs Farrow and Vaughan are with the Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, and the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. Address correspondence to Dr Farrow at the Program in Epidemiology, Fred Hutchinson Cancer Research Center, 1124 Columbia St., MP-474, Seattle, WA 98104, USA. This work was supported by US NIH grants U01CA57949 and R01CA61202.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farrow, D.C., Vaughan, T.L. Determinants of survival following the diagnosis of esophageal adenocarcinoma (United States). Cancer Causes Control 7, 322–327 (1996).

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI:

Key words