Predictors of long-term survival in esophageal carcinoma: Is it the same for all stages?

Abstract

e16152 Background: Survival outcomes in esophageal carcinoma depend on evolving prognostic factors across clinical stages. This study aimed to evaluate those stage-dependent predictors among treated patients. Methods: Patients with esophageal carcinoma were identified from the National Cancer Database (2004–2020). Survival was divided into following groups: 0–2, 2–5, or > 5 years based on months to last contact or death, without censoring. Ordinal logistic regression was performed to model the odds of belonging to a higher survival category. Adjusted odds ratios (aORs) were calculated for demographic, socioeconomic, tumor, and treatment-related factors. Results: Out of 37,429 patients, 16.9% had stage I, 43.5% stage II, 35.1% stage III, and 4.5% stage IV disease. In stage I, uninsured status (aOR 0.24, p < 0.05), Medicare status (aOR 0.71, p < 0.05) and reporting facilities in New England, South Atlantic, East North & South-central regions (aOR < 0.52, p < 0.05) were associated with worse survival, while tumor size had a minimal positive association (aOR 1.00, p = 0.05). In stage II, male sex (aOR 0.74, p < 0.001), higher comorbidity (aOR 0.87, p < 0.001), lower education (aOR 0.78, p < 0.05), Medicare status (aOR 0.76, p < 0.05) and adjuvant radiation (aOR 0.79, p < 0.05) were linked to poorer outcomes. Additionally, all the regions except Pacific (aOR < 0.79, p < 0.05) was associated with worse survival, while median income of $38K-48K (aOR 1.20, p < 0.05) had improved survival. In stage III, male sex (aOR 0.81, p = 0.001), uninsured (aOR 0.68, p < 0.05), Medicare status (aOR 0.71, p < 0.05) and longer time to systemic therapy (aOR 0.97, p < 0.05) were associated with lower survival, whereas well-differentiated histology (aOR 2.10, p < 0.05), absence of 30-day readmission (aOR1.47, p < 0.05) and care in early Medicaid expansion states (aOR 1.30, p < 0.05) improved outcomes. In stage IV, male sex (aOR 0.54, p < 0.05), and prolonged hospitalization (aOR 0.99, p < 0.05) were associated with worse survival, while combined surgery-radiation therapy (aOR 7.99, p < 0.05) was associated with improved survival. Conclusions: Survival drivers in esophageal carcinoma differ across AJCC stages. Sociodemographic factors predominate in early disease, whereas tumor biology and treatment quality drive outcomes in advanced stages. Targeted strategies addressing disparities in insurance coverage, comorbidity management, and access to multidisciplinary care may enhance stage-specific survival.