1444P - Nature trumps nurture: Squamous cell carcinoma remains the leading cause of esophageal cancer in Asian-Americans

Background

In the United States, uniquely American risk factors have led to a rise in the incidence of esophageal adenocarcinoma. In contrast, Asians have generally shown a predominance of esophageal squamous cell carcinoma (SCC), and this has held among Asian-Americans. However, limited investigation of esophageal cancer within Asian-Americans has been conducted in recent years.

Methods

The Surveillance, Epidemiology, and End Results (SEER) Incidence Database was queried for patients from 2004-2020 classified as Asian/Pacific Islander and diagnosed with esophageal adenocarcinoma or squamous cell carcinoma. Descriptive statistics and multivariate models were utilized to compare incidence, cancer characteristics, treatment details, and survival in patients with esophageal adenocarcinoma and SCC.

Results

During this time, 2103 (73.71%) Asian-Americans presented with esophageal SCC compared to 750 (26.29%) with adenocarcinoma. Patients with SCC were diagnosed at a significantly older age (68.09 vs 66.10, p=<0.0001) and had a larger distribution of females (28.72% vs 15.20%, p<0.0001) than those with adenocarcinoma. The distribution of tumor stage was significantly different across these two groups (p<0.0001), with 292 (38.93%) adenocarcinoma patients diagnosed at stage IV compared to 546 (25.96%) patients with SCC. Cox regression analysis revealed that SCC was independently associated with worse survival (Hazard Ratio 1.115 (1.08-1.233)) compared to esophageal adenocarcinoma. Table: 1444P

Conclusions

SCC remains the predominant histological subtype of esophageal cancer within Asian-Americans. Several factors may contribute to this, including BMI, immigration history, and retained cultural practices. However, adenocarcinoma should not be missed in this cohort. The later stage diagnosis of adenocarcinoma suggests that methods to improve early detection are necessary, and poorer survival of the SCC cohort indicates an opportunity to improve treatment paradigms.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.