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Background: Hispanic patients with esophageal cancer (EC) have racially disparate survival outcomes compared with white patients. Objectives:We explored the impact on survival of racial differences in socioeconomic factors, tumor characteristics, and rates of surgical utilization in patients with EC. Method:Using the SEER (Surveillance, Epidemiology, and End Results) registry, we identified 22,531 cases of EC in Hispanic and white patients between the ages of 18 and 65 years in 2003–2014. Of these, 6,250 cases had locoregional EC. Patients were categorized according to age, gender, education, tumor grade, histology, primary tumor site, and surgical status. Postdiagnosis survival was examined over time and compared by race and stratified by surgical status. Results: Compared with whites, Hispanics with EC had significantly higher unadjusted mortality (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.06–1.17; p < 0.001) as did Hispanics with locoregional EC (HR 1.15; 95% CI 1.03–1.29; p = 0.01). In the multivariate analysis, several socioeconomic and tumor factors were found to be independently associated with survival by race, including county of residence income and prevalence of smoking, tumor grade, stage, and primary site, and surgical utilization. After adjusting for demographic and tumor characteristics, surgical utilization in patients with locoregional EC had a significant interaction with race on overall mortality (p = 0.01). Hispanics with locoregional EC were significantly less likely to receive surgery than whites (46 vs. 60%; p < 0.001) and not receiving surgery was associated with a significantly lower overall survival (HR 2.84; 95% CI 2.65–3.04; p < 0.001). Conclusions: A lower rate of surgery among Hispanics with potentially resectable esophageal cancer was associated with a decreased survival rate when compared to whites, even when adjusting for relevant socioeconomic and tumor factors. These data support the need to better address patient barriers to surgical treatment and the systemic biases present in medical care. [ABSTRACT FROM AUTHOR]

Background: In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread.Methods: Data from the Surveillance, Epidemiology, and End Results database of the National Cancer Institute were abstracted from 2004 to 2010 for patients with early-stage esophageal adenocarcinoma. The incidence of lymph node involvement for patients with Tis, T1a, and T1b tumors was examined and was stratified by predictors of spread.Results: A total of 13,996 patients with esophageal adenocarcinoma were evaluated. Excluding those with advanced, metastatic, and/or invasive (T2-T4) disease, 715 patients with Tis, T1a, and T1b tumors were included. On multivariate analysis, tumor grade (odds ratio [OR], 2.76; 95% confidence interval [95% CI], 1.58-4.82 [P<.001]), T classification (OR, 0.47; 95% CI, 0.24-0.91 [P =.025]), and tumor size (OR, 2.68; 95% CI, 1.48-4.85 [P = .001]) were found to be independently associated with lymph node metastases. There was no lymph node spread noted with Tis tumors. For patients with low-grade (well or moderately differentiated) tumors measuring <2 cm in size, the risk of lymph node metastasis was 1.7% for T1a (P<.001) and 8.6% for T1b (P = .001) tumors.Conclusions: For patients with low-grade Tis or T1 tumors measuring ≤2 cm in size, the incidence of lymph node metastasis appears to be comparable to the mortality rate associated with esophagectomy. For highly selected patients with early esophageal adenocarcinomas, the results of the current study support the recommendation that local endoscopic resection can be considered as an alternative to surgical management when followed by rigorous endoscopic and radiographic surveillance. Cancer 2016;122:2150-7. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND The objective of this study was assess differences in the incidence, late-stage diagnosis, and prognosis of squamous cell carcinoma of the esophagus (SCCE), adenocarcinoma of the esophagus (AE), and adenocarcinoma of the gastric cardia (AGC) in metropolitan, urban, and rural areas in the United States. METHODS The authors identified 29,527 patients with SCCE, AE, or AGC who were reported to the Surveillance, Epidemiology, and End Results Program between 2004 and 2009. Incidence estimates for each malignancy were compared across metropolitan, urban, and rural areas. Multivariable logistic regression models were applied to evaluate the association between residential setting and late (distant-stage) diagnosis, and the results were reported as adjusted odds ratios and 95% confidence intervals (CIs). Cox proportional hazard models were used to examine the association between residential setting and cause-specific survival. RESULTS When residential setting was analyzed using metropolitan population centers as the reference category, the incidence of AE was higher in urban areas (rate ratio [RR], 1.13; 95% CI, 1.06-1.20) and rural areas (RR, 1.15; 95% CI, 1.05-1.25), whereas the incidence of SCCE was lower in rural areas (RR, 0.80; 95% CI, 0.70-0.91). Rural patients were less likely to be diagnosed with stage IV AE compared with patients residing in metropolitan areas (odds ratio, 0.79; 95% CI, 0.65-0.97). No differences in prognosis were observed when patients from large metropolitan centers were compared with their rural counterparts. CONCLUSIONS The current findings indicated that preconceptions regarding disparities in the time of diagnosis and survival between patients from metropolitan and rural areas in the United States are either unwarranted or out of date, at least with respect to gastroesophageal cancers. Cancer 2013;119:4020-4027. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]