Trend analysis of survival, socioeconomic, and racial disparities in esophageal squamous cell carcinoma.

Abstract

e16133 Background: Esophageal squamous cell carcinoma (ESCC) remains a lethal malignancy in the US, with historically poor survival. Over the past decade, advances in staging and multimodality therapy have expanded the therapeutic landscape; however, whether these advances have translated into meaningful population-level survival gains has not been well characterized. Using population-based data, we evaluated temporal trends in survival among adults with ESCC, county-level income and race association with disparities in survival outcomes. Methods: We conducted a retrospective cohort study using the SEER database, including adults diagnosed with ESCC between 2010 and 2022. Patients were grouped into three diagnosis eras (2010–2013, 2014–2017, 2018–2022). Overall survival was measured from diagnosis to death from any cause. Because proportional hazards assumptions were violated, survival was summarized using restricted mean survival time (RMST), representing the mean number of months lived over 36 months. County level median household income was categorized into four strata ( < $60k, $60–79k, $80–94k, ≥$95k) as a proxy for socioeconomic access. Race analyses compared non-Hispanic Black and non-Hispanic Asian patients with non-Hispanic White patients. RMST differences and 95% confidence intervals (CI) were estimated for all comparisons. Results: Among 10,391 adults with ESCC, overall survival improved over time. Patients diagnosed in 2018–2022 lived 1.9 months longer during the first 36 months after diagnosis compared with those diagnosed in 2010–2013 (p < 0.001), indicating modest but measurable survival gains. Despite these improvements, substantial disparities were observed. Survival increased monotonically with county level income: compared with patients living in counties with median income < $60k, patients lived 1.3 months longer in $60–79k counties, 3.1 months longer in $80–94k counties, and 3.4 months longer in ≥$95k counties (all p < 0.001). Compared with non Hispanic White patients, non Hispanic Black patients lived an average of 2.7 months fewer, while non Hispanic Asian patients lived 1.2 months longer over the same 36 month period. Conclusions: Although survival among adults with ESCC in the US has improved over time, these gains remain modest and unevenly distributed. Patients living in higher income counties and non Hispanic White or Asian patients experienced longer survival, while non Hispanic Black patients and those in lower income counties had worse outcomes. Clinically, these findings underscore the need to improve equitable delivery of effective therapies. They highlight persistent place based and racial inequities in cancer outcomes. Overall survival by county-level income. County income group N Survival at 36 months (%) Median survival (months) RMST at 36 months <$60k 1758 15.9 6 11.9 $60k-$79k 3354 17.5 8 13.2 $80-$94k 2425 22.7 9 15.0 ≥$95k 2852 23.0 10 15.3