Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma

Table 1 Percentage distribution (weighted for the sampling fraction) of clinical and non-clinical characteristics for gastroesophageal cancer patients diagnosed in 2001 NCI: Patterns of care study (n = 1411) (Wt%)

	Lower esophagus		Gastric cardia		Stomach
	I-III (n = 86)	IV-V (n = 79)	I-III (n = 119)	IV-V (n = 127)	I-III (n = 491)	IV-V (n = 509)
Age
< 70	57.5	46.4	57.2	54.0	36.7	42.4
≥ 70	42.5	53.6	42.8	46.0	63.3	57.6
Marital status
Other	39.9	43.6	37.9	41.0	46.4	48.9
Married	60.1	56.4	62.1	59.0	53.6	51.1
Race
NH White	93.9	87.8	78.0	75.1	51.0	47.9
NH Black	1.0	3.3	4.3	5.8	13.4	14.2
Hispanic	4.1	7.9	11.6	12.0	15.8	20.5
A/PI	1.0	1.0	6.2	6.8	19.1	17.0
NA/AI	0.0	0.0	0.0	0.4	0.6	0.3
Charlson score
Zero	72.3	81.0	77.7	86.5	79.5	78.9
1+	27.7	19.0	22.3	13.5	20.5	21.1
Vital status Dec 2003
Deceased	69.6	88.8	70.0	88.3	53.9	89.9
Histology
Adeno, NOS	92.8	81.0	79.5	70.4	50.4	50.7
A. intestinal	0.0	3.7	9.1	4.1	14.6	7.2
A. diffuse	0.0	0.0	1.8	4.4	4.0	3.0
Signet	6.0	12.0	8.0	18.9	20.6	28.9
Mucinous	1.2	2.4	0.9	1.0	5.5	5.5
Papillary	0.0	0.9	0.7	0.0	0.9	1.5
Tubular	0.0	0.0	0.0	1.0	2.2	0.6
Linus plastica	0.0	0.0	0.0	0.2	1.8	2.6
Linitis plastica/Signet ring
Linitis plastica	3.9	0.0	0.0	4.1	5.3	7.2
Signet	13.9	13.1	15.2	22.4	24.4	33.6
No mention	81.6	86.9	78.3	71.3	69.5	58.5
Unknown	0.6	0.0	6.5	2.2	0.8	0.7
Intestinal metaplasia in resected tumor
None	31.3	28.5	36.7	17.9	25.4	24.3
Metaplasia	7.9	3.0	18.4	5.9	31.2	9.6
No mention	36.6	29.9	30.6	37.5	30.1	28.0
Unknown	24.2	38.6	14.3	38.8	13.3	38.1
Grade
Well differentiated	4.1	12.0	2.9	4.9	6.9	2.3
Moderate	18.9	39.6	31.3	33.4	28.1	19.4
Poor/Undif	57.1	28.5	59.0	51.3	56.5	60.7
Unknown	19.8	20.0	6.8	10.4	8.4	17.7
Barrett’s esophagus
No	21.3	27.7	39.1	19.9	43.4	28.4
Yes	33.2	9.3	11.0	3.8	0.0	0.6
Other	3.9	1.1	1.3	0.0	0.0	0.0
No mention	16.8	21.8	27.8	35.2	43.7	31.5
Unknown	24.8	40.1	20.7	41.1	12.9	39.5
History of Barrett’s
No history	19.3	22.6	27.5	25.6	29.4	29.4
History	22.7	14.0	6.0	8.7	1.7	0.5
No mention	54.5	60.0	59.5	61.8	67.2	67.9
Unknown	3.4	3.4	7.0	3.9	1.8	2.1
H pylori
Negative	22.6	39.2	32.3	29.6	37.6	33.1
Positive	2.1	13.5	10.0	15.9	18.6	15.9
No mention	73.3	41.9	51.1	52.6	41.4	49.0
Pernicious anemia
No history	25.9	33.1	26.9	31.5	31.1	28.7
Pernicious Anemia	0.6	0.0	8.2	0.4	6.1	3.9
No mention	71.5	62.0	60.4	65.4	59.6	64.9
Unknown	2.0	4.9	4.5	2.7	3.2	2.6
History of ulcers
No history	23.5	32.6	28.2	29.5	19.6	23.1
Peptic ulcers, NOS	7.9	11.6	5.8	4.7	12	10.5
Duod/pyloric ulcer	2.1	1.7	0.4	1.3	1.1	2.9
Gastric ulcer	4.3	0	8.6	9.6	22.7	13.3
Other	6.5	7.1	0.4	1.4	0.9	0.8
No mention	55.1	44.7	50.1	51	40.6	46.9
Unknown	0.6	2.4	6.6	2.4	3.1	2.5

American Indians/Native American are included in Table 1 for completeness of reporting. Histology groupings were created according to the following: Adenocarcinoma-NOS = 8140, 8210, 8255, 8261 (n = 842), Adeno-Intestinal = 8144 (n = 122), Adeno-Diffuse = 8145 (n = 45), Signet Cell = 8490 (n = 295), Mucinous/mucin-producing = 8480 + 8481 (n = 48), Papillary/Serous = 8260 + 8460 + 8461 (n = 12), Tubular = 8211 (n = 17), Linitis plastica = 8142 (n = 23).

Table 2 Percentage distribution (weighted for the sampling fraction) of treatment characteristics and survival for gastroesophageal adenocarcinoma patients diagnosed in 2001 NCI: Patterns of care study (n = 1356)¹ (Wt%)

	Lower esophagus		Gastric cardia		Stomach
	I-III	IV-V	I-III	IV-V	I-III	IV-V
Therapy received
Surgery only	12.3	1.3	34	2.2	49.6	15.7
Radiation only	8.1	3.5	4.7	7.2	2	3.3
Chemotherapy only	0.5	24	1.2	21.9	3.6	22.1
Surgery and radiation	0.8	0	2.6	0.9	3.9	0.4
Surgery and chemo	2.5	1.3	8.6	4.8	3.2	5.6
Surgery, rad, chemo	27	4.6	25	11.2	19.2	6.1
Chemo and radiation	36.5	46.8	9.8	12.4	1.5	3.4
None	12.4	18.7	14.1	39.4	17.1	43.4
Chemotherapy
No chemo	25.1	21.5	48.7	40.8	64.9	54.5
Single agent	5.4	25.5	11.4	9.9	10.3	8.4
Multi-agent	61.1	50.9	31.4	39.6	17.1	29
Refused	5.9	1.5	4.3	7.2	4	4.3
Rec, unknown if given	1.9	0	1	2.1	1.8	2.3
Unknown	0.6	0.6	3.2	0.4	2	1.5
Chemotherapy agent
5-FU	58.6	37.9	35.7	34.7	23.2	26.4
Doxorubicin	0.5	0	0.3	1	0.5	3.4
Capecitabine	1.2	0	0.7	7.4	0.6	4
Cisplatin	38.7	37.2	22	17.2	2.8	10.8
Etoposid	1	0	0.7	10.7	1.4	5.8
Irinotecan	0.7	12.9	0.5	5.9	1.6	5.6
Leucovorin	4.1	0.9	6.1	21.8	12.1	15.1
Mitomycin-C	13.	4.3	0.5	0.6	0.2	1.8
Oxaliplatin		No one
Epirubicin	0	0	0	1	0	1.2
Paclitaxel	11.8	20.8	5.9	7.3	2.2	4.6
Docetaxel	0	1.6	0.7	2.1	0.6	1.4
Chemotherapy plus surgery (with or without radiation)
No	70.5	94.2	68.3	84	77.7	87.8
Pre-op	23.7	4.9	16.8	6.4	0.3	0.5
Post-op	5.8	0.9	9	8.5	20.3	11.2
Unknown	0	0	5.9	1.1	1.7	0
Surgery plus chemotherapy and radiation
No	73	95.4	75	88.5	80.9	93.9
Pre-op	21.9	4.6	13.4	4.3	0.2	0.5
Post-op	5.1	0	8.6	6.9	17.4	5.6
Unknown	0	0	3	0	1.5	0
Median survival time (mo)
Non-surgical pts	13	8	8	6	5	4
Surgical patients	22	13	19	13	26	6

¹13 American Indians/Native Americans excluded.

Table 3 Therapy among patients with gastroesophageal adenocarcinoma by anatomic site, 2001: Multinomial logistic regression for the receipt of chemoradiation (Chemo + RT) and chemotherapy alone

Site characteristic	Lower esophagus					Gastric-cardia					Stomach
	Chemo + RT		Chemo			Chemo + RT		Chemo			Chemo + RT		Chemo
	OR	95% CI	OR	95% CI	P	OR	95% CI	OR	95% CI	P	OR	95% CI	OR	95% CI	P
Age					0.05					< 0.001					< 0.001
< 70	1		1			1		1			1		1
≥ 70	0.3	0.1-0.96	0.2	0.03-0.9		0.2	0.1-0.4	0.3	0.1-0.7		0.2	0.1-0.4	0.2	0.1-0.3
Race/ethnicity					0.33					0.64					0.24
Non-hispanic white	1		1			1		1			1		1
Non-hispanic black	1.1	0.1-10.2	0.9	0.1-14.5		0.5	0.1-1.7	1	0.2-6.7		1.3	0.6-2.5	0.6	0.3-1.0
Hispanic	0.1	0.01-0.9	0.3	0.02-3.6		0.4	0.1-1.6	1.6	0.3-7.4		1.2	0.6-2.5	0.6	0.3-1.4
Asian/Pacific Islander						0.5	0.1-1.9	1.4	0.4-4.9		1.7	0.9-3.4	0.8	0.4-1.4
Gender					0.32					0.01					0.64
Male	1		1			1		1			1		1
Female	1.2	0.5-3.3	0.3	0.04-2.1		1.2	0.4-3.3	0.3	0.1-0.8		1.3	0.8-2.1	1.1	0.7-1.8
Marital status					0.28					0.86					0.74
Not married	1		1			1		1			1		1
Married	2.1	0.7-6.5	1	0.3-3.9		1	0.4-2.6	1.4	0.4-4.6		1.2	0.7-2.0	1.2	0.7-1.9
Stage					0.12					0.01					< 0.001
I-III	1		1			1		1			1		1
IV & unknown	1	0.4-2.7	3.6	0.9-13.6		0.7	0.3-1.7	3.	1.3-11.4		0.6	0.4-0.9	5.2	3.0-8.8
Differentiation grade					0.57					0.36					0.38
Well/Moderately differentiated	1		1			1					1		1
Poorly/Undifferentiated	1.2	0.4-3.6	0.9	0.2-3.7		0.8	0.3-1.9	1	0.3-3.1		1.3	0.7-2.2	1.3	0.7-2.5
Unknown	0.6	0.2-1.9	0.2	0.03-1.4		1.5	0.3-7.3	0.2	0.03-1.8		0.7	0.3-2.0	1.6	0.8-3.5
Charlson score					0.25					0.02					0.35
0	1		1			1		1			1		1
1+	2	0.6-6.7	0.6	0.1-3.1		0.4	0.1-1.3	0.1	0.02-0.6		0.7	0.4-1.2	0.9	0.5-1.7
H pylori					0.02					0.004					0.65
No	1		1			1		1			1		1
Yes	0.1	0.02-0.8	0.4	0.03-5.6		1	0.2-4.2	0.4	0.1-2.1		1.2	0.6-2.5	1.3	0.6-2.8
Unknown	0.1	0.03-0.4	0.2	0.03-0.8		0.2	0.1-0.7	0.8	0.3-2.3		1	0.6-1.7	1.5	0.9-2.5

Model also adjusted for registry.

Table 4 Cox proportional hazards model for cancer death among lower esophageal and GCA patients overall (Model 1) and among SAC patients who did or did not receive surgery (Model 2)

	Model 1						Model 2
	Lower esophagus (n = 164)			Gastric-cardia (n = 241)			Stomach
	With & Without surgery			With & Without surgery			No surgery (n = 461)			With surgery (n = 490)
Characteristic	HR	95% CI	P	HR	95% CI	P	HR	95% CI	P	HR	95% CI	P
Age & co-morbidity			0.02			0.44			0.97			0.01
< 70, Charlson score = 0	1			1			1			1
< 70, Charlson score = 1	2.7	1.4-5.2		1	0.4-2.1		0.9	0.6-1.4		2	1.1-3.7
70+, Charlson score = 0	1.5	0.9-2.6		1.4	0.9-2.3		0.9	0.6-1.4		1.5	0.9-2.5
70+, Charlson score = 1	1.5	0.7-3.3		1.1	0.5-2.4		1	0.6-1.6		2.4	1.4-4.0
Race			< 0.001			0.08			0.39			0.003
Non-Hispanic White	1			1			1			1
Non-Hispanic Black	3.4	1.8-6.7		0.8	0.5-1.2		1.1	0.8-1.5		1.1	0.6-1.7
Hispanic	1	0.5-2.0		1.3	0.8-2.2		0.8	0.5-1.2		1.3	0.8-2.1
Asian/Pacific Islander	6.4	2.9-14.4		0.4	0.2-1.0		0.9	0.6-1.2		0.5	0.3-0.9
Gender			0.78			0.87			0.84			0.18
Male	1			1			1			1
Female	0.9	0.6-1.5		1	0.6-1.4		1	0.8-1.4		0.8	0.5-1.1
Marital Status			0.43			0.01			0.39			0.33
Not married	1			1			1			1
Married	0.8	0.5-1.3		0.6	0.4-0.9		1.2	0.8-1.6		1.2	0.8-1.9
Stage			< 0.001			< 0.001			0.004			< 0.001
Stage I-III	1			1			1			1
Stage IV & unknown	2.5	1.5-4.2		2.6	1.6-4.0		1.7	1.2-2.3		5	3.4-7.4
Differentiation grade			0.11			0.049			0.01			0.14
Well/Moderately	1			1			1			1
Poorly/Undifferentiated	1.8	1.0-3.3		1.7	1.1-2.6		1.8	1.2-2.6		1.4	0.9-2.2
Unknown	1.7	0.9-3.2		1.3	0.6-2.8		1.5	1.0-2.3		0.7	0.3-1.7
Chemotherapy			0.09			0.68			< 0.001			0.12
No	1			1			1			1
Yes	0.6	0.4-1.1		1.1	0.7-1.8		0.6	0.4-0.8		0.7	0.5-1.1

Table 5 Percentage distribution (weighted for the sampling fraction) of chemotherapy agents by selected therapeutic combinations gastroesophageal adenocarcinoma patients diagnosed in 2001; NCI: Patterns of care study (n = 1356)¹ (Wt%)

	Lower esophagus		Gastric-cardia		Stomach
	I-III	IV-V	I-III	IV-V	I-III	IV-V
Chemotherapy only
Etoposide + Doxorubicin + Cisplatin	1 patient	0	0	0	0	0.6
5-FU only	0	3.2	0	3.3	15.9	5.1
Mitomycin only	0	16.7	0	0	0	0
Paclitaxel only	0	2.1	19.2	3.3	0	0
Capcitabine only	0	0	0	0	0	4.4
Gemcitabine only	0	0	0	3.1	0	1.2
5-FU + 1 agent	0	18	56	16.6	25.5	18.8
5-FU + 2 agents	0	4	24.8	40	26.6	23.3
5-FU + 3 agents	0	0	0	7.9	0	15.6
5-FU + 4 agents	0	0	0	2.6	0	2.2
Irinotecan + Paclitaxel	0	20.6	0	1.2	0	0.6
Irinotecan + Cisplatin	0	15.4	0	1.7	0	8.4
Irinotecan + Cisplatin + Paclitaxel	0	0	0	0	20.4	0
Other	0	20	0	20	11.7	19.7
Radiation and chemotherapy
5-FU only	2.1	9.2	34.8	29.2	5.6	20.6
Cisplatin only	0	17.1	0	3.3	0	0
5-FU + Leucovorin	0	1.2	0	0	0	14.3
5-FU + Cisplatin	50.6	28	61.5	32.6	7.9	0
5-FU + Mitomycin	25.1	0.7	0	0	0	0
5-FU + Irinotecan	0	0	0	0	30.1	0
Paclitaxel + Carboplatin	0	13.6	0	4.7	0	0
Chemo, NOS	4.6	8.9	0	7.5	20	13.1
Other	17.6	21.3	3.7	22.7	36.4	52
Surgery, radiation & chemotherapy
5-FU only	5	0	9.4	0	32.4	26.5
5-FU + Leucovorin	13.3	0	17.6	31.7	46.5	40.9
5-FU + Cisplatin	41.1	15.6	27.7	7.3	2.3	0
5-FU + Paclitaxel + Carboplatin	15.3	44.6	1.6	0	0.7	0
Other agents/Combos	25.3	39.8	43.7	61	18.1	32.6

¹13 American Indians/ Native Americans excluded;

NOS: Not otherwise specified.