Treatment Modalities for Esophageal Adenocarcinoma in the United States: Trends and Survival Outcomes

Background: Owing to the rising incidence of esophageal adenocarcinoma (EAC), we sought to assess the national trends in the use of different treatment modalities and compare survival outcomes among them. Methods: Using Surveillance, Epidemiology, and End Results (SEER) Program registry (2004-2014), we identified adult patients diagnosed with EAC undergoing definitive chemoradiotherapy (dCRT), esophagectomy, or neoadjuvant chemoradiotherapy plus esophagectomy (nCRT/S). Linear trends in the yearly incidence of each treatment were assessed using Poisson regression. An inverse probability of treatment weighted (IPTW) Cox regression was used to estimate the effect of each treatment on mortality. IPTW was used to account for potential confounding by year of diagnosis, patient demographics, and cancer characteristics. Results: A total of 10,755 patients were included in the study. From 2004 to 2014, the use of esophagectomy alone decreased from 15% to 5% (P < .0001), whereas nCRT/S increased from 14% to 20% (P < .0001); dCRT remained relatively stable (26% to 29%, P = .08). The 60-month survival rate was 13.0% for dCRT, 33.0% for esophagectomy only, and 36.3% for nCRT/S. After accounting for patient and cancer characteristics, both esophagectomy (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.55-0.70, P < .0001) and nCRT/S (HR 0.45, 95% CI 0.41-0.48, P < .0001) had significantly the highest survival rates. Conclusion: The use of esophagectomy alone has decreased, whereas nCRT/S has increased among EAC patients. Considering the better outcomes achieved with surgical resection, the use of dCRT should be discouraged in surgically fit patients.