Patients younger than 45 years of age have superior 5-year survival in advanced esophageal cancer

Background: Esophageal cancer is an aggressive malignancy that most commonly presents in the sixth and seventh decade of life. However, there are a subset of patients that present with esophageal cancer at a very young age (<45 years). The aim of this study was to analyze the outcomes of treatment of patients diagnosed with esophageal cancer at a young age when matched to older patients of the same stage in order to better understand the natural history of esophageal cancer in this group of patients. Methods: This study was performed through a retrospective review of patients who underwent esophageal resection performed at our institution from 1985 to 2014 identified 82 patients who were under the age of 45 when they underwent surgical resection for esophageal cancer. This cohort of patients were matched to a cohort of patients who had the same stage, sex, neoadjuvant therapy, pathology, and year of diagnosis within 5 years but were older than 45 years old when they underwent esophageal resection. Results: There was no significant difference in survival between the younger and older cohort of patients with stage I or II disease. Patients with stage III/IV esophageal cancer under the age of 45 had 1-, 3-, and 5-year survival of 88.6%, 31.8% and 24.2%, while in the older matched cohort 1-, 3-, and 5-year survival was 58.3%, 20.6%, 8.8% [P=0.04, hazard ratio (HR) 1.72]. Conclusions: While age doesn’t affect overall survival of early-stage esophageal cancer, patients under the age of 45 with advanced esophageal cancer have superior overall survival compared to older patients.