Esophageal cancer in young patients: does age affect treatment course and outcomes?

Background: Young patients with esophageal cancer (EC) are believed to have more aggressive disease, thus thought to have worse survival. Herein, we aim to study the impact of younger age on the short- and long-term outcomes of esophagectomy for EC. Methods: Patients who underwent esophagectomy for EC at our institution between 1994–2019 were included. Age 50 was defined as the cutoff for “young” vs . “old”. Patients from each age group were propensity-score matched 1:1 to compare postoperative and survival outcomes. Results: Our database reported 1,031 patients, 112 of whom were in the ‘young’ group. For the unmatched analysis, young patients were more likely to have squamous cell carcinoma, higher rates of locally advanced disease, and subsequently higher rates of neoadjuvant chemotherapy (79.5% vs . 68.3%; P=0.047). After matching for pre-treatment clinical factors, young patients were less likely to have pulmonary or cardiac complications after surgery, and three times more likely to receive AC despite matching for stage and response to treatment (26.7% vs . 7.9%; P=0.002). Then, we matched patients including receipt of AC to study survival. In the second match, median recurrence-free survival (RFS) for young patients was 49.0±26.0 vs . old 27.0±5.4 months (P=0.215). Median overall survival (OS) for young was 73.0±28.9 vs . old 31.0±6.3 months (P=0.073). Conclusions: Young EC patients tend to present with more advanced disease. However, when matched for stage and response to therapies, young patients were three-times more likely to be offered AC. After adjusting for receipt of adjuvant therapy no difference was detected in RFS.