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Population Based Time Trends in the Epidemiology and Mortality of Gastroesophageal Junction and Esophageal Adenocarcinoma

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A Correction to this article was published on 23 January 2024

A Concise Commentary to this article was published on 01 November 2023

This article has been updated

Abstract

Background

Limited data are available on the epidemiology of gastroesophageal junction adenocarcinoma (GEJAC), particularly in comparison to esophageal adenocarcinoma (EAC). With the advent of molecular non-endoscopic Barrett’s esophagus (BE) detection tests which sample the esophagus and gastroesophageal junction, early detection of EAC and GEJAC has become a possibility and their epidemiology has gained importance.

Aims

We sought to evaluate time trends in the epidemiology and survival of patients with EAC and GEJAC in a population-based cohort.

Methods

EAC and GEJAC patients from 1976 to 2019 were identified using ICD 9 and 10 diagnostic codes from the Rochester Epidemiology Project (REP). Clinical data and survival status were abstracted. Poisson regression was used to calculate incidence rate ratios (IRR). Survival analysis and Cox proportional models were used to assess predictors of survival.

Results

We included 443 patients (287 EAC,156 GEJAC). The incidence of EAC and GEJAC during 1976–2019 was 1.40 (CI 1.1–1.74) and 0.83 (CI 0.61–1.11) per 100,000 people, respectively. There was an increase in the incidence of EAC (IRR = 2.45, p = 0.011) and GEJAC (IRR = 3.17, p = 0.08) from 2000 to 2004 compared to 1995–1999, plateauing in later time periods. Most patients had associated BE and presented at advanced stages, leading to high 5-year mortality rates (66% in EAC and 59% in GEJAC). Age and stage at diagnosis were predictors of mortality.

Conclusion

The rising incidence of EAC/GEJAC appears to have plateaued somewhat in the last decade. However, both cancers present at advanced stages with persistently poor survival, underscoring the need for early detection.

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Change history

Abbreviations

BE:

Barrett’s esophagus

BMI:

Body Mass Index

CCD:

Cell collection device

CI:

Confidence interval

EAC:

Esophageal adenocarcinoma

EGD:

Esophagogastroduodenoscopy

GEJAC:

Gastro-esophageal junction adenocarcinoma

GERD:

Gastro-esophageal reflux disease

IQR:

Inter-quartile range

IRR:

Incidence rate ratio

REP:

Rochester Epidemiology Project

SD:

Standard deviation

SEER:

Surveillance epidemiology and end-results

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Funding

Supported in part by the Freeman Foundation. NCI grant (CA 241164).

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Author notes

  1. Siddharth Agarwal and Matthew G. Bell have contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Barrett’s Esophagus Unit, Mayo Clinic, Rochester, MN, USA

    Siddharth Agarwal, Lovekirat Dhaliwal, D. Chamil Codipilly, Ramona Lansing, Erin E. Gibbons, Cadman L. Leggett, John B. Kisiel & Prasad G. Iyer

  2. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Matthew G. Bell

  3. Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA

    Ross A. Dierkhising

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Contributions

SA, MB, PGI: Study concept and design. SA, MB, LD: Acquisition of data. RD, SA, MB, LD, JBK, PGI: Analysis and interpretation of data. SA, MB, RD, CDC: Drafting of manuscript. CDC, CL, JBK, PGI: Critical revision of manuscript for important intellectual content.

Corresponding author

Correspondence to Prasad G. Iyer.

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Conflict of interest

Siddharth Agarwal, Matthew G Bell, Lovekirat Dhaliwal, D. Chamil Codipilly, Ross Dierkhising, Ramona Lansing, Erin Gibbons: None. Cadman Leggett: Research support but no direct monetary compensation from Nine Point Medical. John B. Kisiel: Sponsored research, consulting, and intellectual property agreements with Exact Sciences, paid to Mayo Clinic. Prasad G. Iyer: Research funding from Exact Sciences, Pentax Medical, Consulting: Medtronic.

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Agarwal, S., Bell, M.G., Dhaliwal, L. et al. Population Based Time Trends in the Epidemiology and Mortality of Gastroesophageal Junction and Esophageal Adenocarcinoma. Dig Dis Sci 69, 246–253 (2024). https://doi.org/10.1007/s10620-023-08126-6

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